MEDICARE: DR. STEVEN RICHARD WERT 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	12008833	IN

General Provider Information

NPI Number	:	1962560433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN RICHARD WERT DDS

Provider Business Mailing Address
First Line	:	1910 ST JOE CENTER ROAD
Second Line	:	UNIT #21
City	:	FT WAYNE
State	:	IN
Zip	:	46825-5000
Country	:	US
Telephone Number	:	260-483-4588
Fax Number	:	260-471-8427

Provider Business Practice Location Address
First Line	:	1910 ST JOE CENTER ROAD
Second Line	:	UNIT #21
City	:	FT WAYNE
State	:	IN
Zip	:	46825-5000
Country	:	US
Telephone Number	:	260-483-4588
Fax Number	:	260-471-8427

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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