Healthcare Provider Details

I. General information

NPI: 1487892634
Provider Name (Legal Business Name): ROBERT ALAN WERNER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBERT A. WERNER DMD

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 NORTH MAIN ST.
FLORIDA NY
10921
US

IV. Provider business mailing address

14 NORTH MAIN ST.
FLORIDA NY
10921
US

V. Phone/Fax

Practice location:
  • Phone: 845-651-4647
  • Fax: 845-651-4686
Mailing address:
  • Phone: 845-651-4647
  • Fax: 845-651-4686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number032097
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: