MEDICARE: JODIE ROCHELLE WERTH DDS

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	122300000X	Dentist	61403	KS

General Provider Information

NPI Number	:	1841783271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODIE ROCHELLE WERTH DDS

Provider Business Mailing Address
First Line	:	1318 JUDITH DR APT B
Second Line	:
City	:	HAYS
State	:	KS
Zip	:	67601-4829
Country	:	US
Telephone Number	:	620-290-2257
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N MAIN ST
Second Line	:
City	:	RUSSELL
State	:	KS
Zip	:	67665-2731
Country	:	US
Telephone Number	:	785-483-2411
Fax Number	:

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

Provider Enumeration Date	:	06/11/2018
Last Update Date	:	06/11/2018

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