Provider Demographics
NPI:1366332736
Name:JEFFREY R. WERT DMD PC
Entity type:Organization
Organization Name:JEFFREY R. WERT DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE ASSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-710-1851
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:TANNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18372-0485
Mailing Address - Country:US
Mailing Address - Phone:570-629-1570
Mailing Address - Fax:
Practice Address - Street 1:2796 ROUTE 611
Practice Address - Street 2:
Practice Address - City:TANNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18372
Practice Address - Country:US
Practice Address - Phone:570-629-1570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty