Provider Demographics
NPI:1336508670
Name:WERMERS, JOHNATHAN (DMD)
Entity Type:Individual
Prefix:MR
First Name:JOHNATHAN
Middle Name:
Last Name:WERMERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MN
Mailing Address - Zip Code:56296-1040
Mailing Address - Country:US
Mailing Address - Phone:320-563-4800
Mailing Address - Fax:
Practice Address - Street 1:1511 BROADWAY
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MN
Practice Address - Zip Code:56296-1040
Practice Address - Country:US
Practice Address - Phone:320-563-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14540122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist