Healthcare Provider Details

I. General information

NPI: 1720493695
Provider Name (Legal Business Name): KELSEY MARIE WERNER D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 04/26/2016
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
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 Number30.024283
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: