MEDICARE: JENNIFER WEERTS OMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	27204	CA

General Provider Information

NPI Number	:	1366373524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER WEERTS OMT

Provider Business Mailing Address
First Line	:	1960 BLUE OAKS BLVD STE 190
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95747-8486
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 GIBSON DR STE 190
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-5796
Country	:	US
Telephone Number	:	916-237-7127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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