Provider Demographics
NPI:1538245428
Name:WERTS, CARL DAMIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:DAMIAN
Last Name:WERTS
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 1:633 N CENTRAL AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1801
Mailing Address - Country:US
Mailing Address - Phone:818-241-1824
Mailing Address - Fax:818-241-2016
Practice Address - Street 1:633 N CENTRAL AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1801
Practice Address - Country:US
Practice Address - Phone:818-241-1824
Practice Address - Fax:818-241-2016
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA290011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice