Provider Demographics
NPI:1104899806
Name:WERTZ, DAVID ANDREW (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:WERTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2304
Mailing Address - Country:US
Mailing Address - Phone:303-604-6092
Mailing Address - Fax:
Practice Address - Street 1:801 MAIN ST
Practice Address - Street 2:220
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1864
Practice Address - Country:US
Practice Address - Phone:303-926-8225
Practice Address - Fax:303-604-6369
Is Sole Proprietor?:No
Enumeration Date:2006-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO73921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice