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NPI Code Detail

MEDICARE: DR. JACK JOSEPH WEHRLY DDS

MEDICARE: DR. JACK JOSEPH WEHRLY 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
11223G0001XGeneral Practice Dentistry12008160AIN

General Provider Information

NPI Number : 1942359393
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK JOSEPH WEHRLY DDS
Provider Business Mailing Address
First Line : 3303 TRIER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-4768
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3303 TRIER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-4768
Country : US
Telephone Number : 260-484-4438
Fax Number : 260-482-6204
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 07/08/2007

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