Glenn Alan Wergin, DMD
Individual provider Active NPI Dentist · Walworth, WI
NPI 1821149758 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1821149758
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 1397G (WI)
- Practice address
- 100 N Main St
Walworth, WI 53184 - Phone
- (262) 275-6992
- Fax
- (262) 275-6992
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1397G | WI | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1397G | WI | Yes |
Addresses
Primary practice location
100 N Main St
Walworth, WI 53184
Mailing address
100 N Main St
P O Box 923
Walworth, WI 53184
Phone (262) 275-6992
Other providers in Walworth, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.