Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 4287 | KY |
NPI | 1023210226 |
---|---|
Provider Name | Mark M Wehrman |
First Address | Crestview Hills, KY 41017-3424 |
Second Address | Crestview Hills, KY 41017-3424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
61942561 | (05) | KY |