Healthcare Provider Details

I. General information

NPI: 1386851517
Provider Name (Legal Business Name): EDWARD JAMES WERRE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 DAKOTA AVE
WAHPETON ND
58075-4413
US

IV. Provider business mailing address

419 DAKOTA AVE
WAHPETON ND
58075-4413
US

V. Phone/Fax

Practice location:
  • Phone: 701-642-1411
  • Fax:
Mailing address:
  • Phone: 701-642-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1511
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: