Provider Demographics
NPI:1255536546
Name:WERTHEIMER, JACLYN MEREDITH (DMD)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:MEREDITH
Last Name:WERTHEIMER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1750
Mailing Address - Country:US
Mailing Address - Phone:610-892-9088
Mailing Address - Fax:
Practice Address - Street 1:610 E BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1750
Practice Address - Country:US
Practice Address - Phone:610-892-9088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0368551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice