Healthcare Provider Details

I. General information

NPI: 1295804334
Provider Name (Legal Business Name): JEREMY P WEHRMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 4TH ST N
FARGO ND
58102-4820
US

IV. Provider business mailing address

PO BOX 2625
FARGO ND
58108-2625
US

V. Phone/Fax

Practice location:
  • Phone: 701-239-7111
  • Fax:
Mailing address:
  • Phone: 701-239-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1959
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number11940
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: