Myriel Jamae Werner, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1002398 Issued in WI

Practice address

125 N High St
Randolph, WI 53956-1267

Phone

(920) 326-3191

NPI assigned

Aug 10, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Randolph Family Dental LLC

  • General Practice Dentistry
  • Randolph, WI
  • NPI 1154711190
  NPD (past)
• Silver Creek Dentistry LLC

  • Dentist
  • Ripon, WI
  • NPI 1053857508
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1457961971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 N HIGH ST",
            "city": "RANDOLPH",
            "state": "WI",
            "postal_code": "539561267",
            "telephone_number": "920-326-3191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 N HIGH ST",
            "city": "RANDOLPH",
            "state": "WI",
            "postal_code": "539561267",
            "telephone_number": "920-326-3191"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1209 W Fond Du Lac St",
            "address_purpose": "LOCATION",
            "city": "Ripon",
            "state": "WI",
            "postal_code": "549719289",
            "country_code": "US",
            "telephone_number": "920-748-7200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WERNER",
        "first_name": "MYRIEL",
        "middle_name": "JAMAE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-10",
        "last_updated": "2023-11-27",
        "certification_date": "2020-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1002398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "rdwdds@centurytel.net",
            "affiliation": "Y",
            "affiliationName": "Randolph Family Dental LLC",
            "address_1": "125 N High St",
            "city": "Randolph",
            "state": "WI",
            "country_code": "US",
            "postal_code": "539561267",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emily J Seltzner, RD
• Wendy Lunnette Sherwood, IBCLC
• Tara Sosalla
• Samantha Sussek
• Patricia Jean Vanburen, RN
• Ross D Werner, DDS
• Teresa J Wiersma, NP
• Within Reach LLC
• Rebecca Yelle, OTR/L

• General Practice Dentistry in Randolph, WI
• Providers in Randolph, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.