Healthcare Provider Details

I. General information

NPI: 1689765646
Provider Name (Legal Business Name): PATTI LEE WERTHER D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E LANCASTER AVE SUITE 201
ARDMORE PA
19003-2321
US

IV. Provider business mailing address

233 E LANCASTER AVE SUITE 201
ARDMORE PA
19003-2321
US

V. Phone/Fax

Practice location:
  • Phone: 610-649-2470
  • Fax: 610-896-5425
Mailing address:
  • Phone: 610-649-2470
  • Fax: 610-896-5425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS-020687-L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS020687L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: