Provider Demographics
NPI:1487892634
Name:WERNER, ROBERT ALAN (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:WERNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:A
Other - Last Name:WERNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:14 NORTH MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:NY
Mailing Address - Zip Code:10921
Mailing Address - Country:US
Mailing Address - Phone:845-651-4647
Mailing Address - Fax:845-651-4686
Practice Address - Street 1:14 NORTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10921
Practice Address - Country:US
Practice Address - Phone:845-651-4647
Practice Address - Fax:845-651-4686
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist