Provider Demographics
NPI:1912089871
Name:WERTHER, JOHN ROBERT (DMD MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:WERTHER
Suffix:
Gender:
Credentials:DMD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N
Mailing Address - Street 2:SUITE 606
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2131
Mailing Address - Country:US
Mailing Address - Phone:615-284-5650
Mailing Address - Fax:615-284-5653
Practice Address - Street 1:300 20TH AVE N
Practice Address - Street 2:SUITE 606
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2131
Practice Address - Country:US
Practice Address - Phone:615-284-5650
Practice Address - Fax:615-284-5653
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54241223S0112X
TN21127204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4002094OtherBLUE CROSS BLUE SHIELD
1477635324OtherGROUP NPI
E99810Medicare UPIN