Provider Demographics
NPI:1669602538
Name:WERMERSON, CHRISTOPHER PAUL (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:WERMERSON
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 1:5200 S CLIFF AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5400
Mailing Address - Country:US
Mailing Address - Phone:605-274-0555
Mailing Address - Fax:605-274-0155
Practice Address - Street 1:5200 S CLIFF AVE STE 102
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5400
Practice Address - Country:US
Practice Address - Phone:605-274-0555
Practice Address - Fax:605-274-0155
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD09211223X0400X
IA30397390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics