Healthcare Provider Details

I. General information

NPI: 1710058250
Provider Name (Legal Business Name): DANIEL F. WERNIMONT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DANIEL F. WERNIMONT DDS. PC

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 3RD AVE NW
POCAHONTAS IA
50574-1602
US

IV. Provider business mailing address

102 3RD AVE NW
POCAHONTAS IA
50574-1602
US

V. Phone/Fax

Practice location:
  • Phone: 712-335-4132
  • Fax: 712-335-4579
Mailing address:
  • Phone: 712-335-4132
  • Fax: 712-335-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number06658
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: