Provider Demographics
NPI:1144355983
Name:WERNER, JOHN ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:WERNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-7813
Mailing Address - Country:US
Mailing Address - Phone:509-304-4370
Mailing Address - Fax:
Practice Address - Street 1:619 S WASHINGTON ST STE 303
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3063
Practice Address - Country:US
Practice Address - Phone:208-883-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-44131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice