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General NPI Number Information
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NPI Number | 1629673058
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Entity Type | Individual
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Provider Name | SHEREE FOSHEE WERTZ BS, RDH, OMT
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Gender | Female
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 19615 GOVERNORS HWY
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City | FLOSSMOOR
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State | IL
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Zip | 60422-2037
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Country | US
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Telephone | 708-221-8343
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 244
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City | BOURBONNAIS
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State | IL
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Zip | 60914-0244
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Country | US
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Telephone | 815-922-1288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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