MEDICARE: DESIREE F WINTERHALTER D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	18140	MA

General Provider Information

NPI Number	:	1871762815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE F WINTERHALTER D.M.D.

Provider Business Mailing Address
First Line	:	609 DARTMOUTH ST
Second Line	:
City	:	SOUTH DARTMOUTH
State	:	MA
Zip	:	02748-2516
Country	:	US
Telephone Number	:	508-996-0922
Fax Number	:	508-997-4487

Provider Business Practice Location Address
First Line	:	609 DARTMOUTH ST
Second Line	:
City	:	SOUTH DARTMOUTH
State	:	MA
Zip	:	02748-2516
Country	:	US
Telephone Number	:	508-996-0922
Fax Number	:	508-997-4487

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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