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General NPI Number Information
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NPI Number | 1306190988
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Entity Type | Organization
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Legal Business Name | JOHN A WERNER PLLC
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Dates
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Enumeration Date | 11/03/2012
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Last Update Date | 11/03/2012
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Provider Practice Location Address
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Address Line | 619 S WASHINGTON ST STE 303
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City | MOSCOW
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State | ID
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Zip | 83843-3063
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Country | US
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Telephone | 208-883-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 676 VICTORIA DR
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City | MOSCOW
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State | ID
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Zip | 83843-7813
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Country | US
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Telephone | 509-304-4370
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JOHN ANDREW WERNER
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Credential | D.D.S.
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Telephone | 509-304-4370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D-4413
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License Number State | ID
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