Healthcare Provider Details

I. General information

NPI: 1689606378
Provider Name (Legal Business Name): SCOTT ALAN WERNER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2000 MILTON BLVD
NEWTON FALLS OH
44444-9793
US

IV. Provider business mailing address

2000 MILTON BLVD
NEWTON FALLS OH
44444-9793
US

V. Phone/Fax

Practice location:
  • Phone: 330-872-5737
  • Fax: 330-872-7400
Mailing address:
  • Phone: 330-872-5737
  • Fax: 330-872-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17999
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: