MEDICARE: DR. JOHN ANDREW WERNER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D-4413	ID

General Provider Information

NPI Number	:	1144355983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ANDREW WERNER D.D.S.

Provider Business Mailing Address
First Line	:	676 VICTORIA DR
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-7813
Country	:	US
Telephone Number	:	509-304-4370
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 S WASHINGTON ST STE 303
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-3063
Country	:	US
Telephone Number	:	208-883-7777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	11/03/2012

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