Provider Demographics
NPI:1295240331
Name:WERNER, MARIA (RDH)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:WERNER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:TEJEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 NEILSON ST ATTN: DENTAL DEPT.
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2468
Mailing Address - Country:US
Mailing Address - Phone:831-728-8250
Mailing Address - Fax:831-707-2777
Practice Address - Street 1:45 NEILSON ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2468
Practice Address - Country:US
Practice Address - Phone:831-728-8250
Practice Address - Fax:831-707-2777
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25377124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist