MEDICARE: STASIA D. WINFORD, DMD, P.A.

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	2846-94	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982976817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STASIA D. WINFORD, DMD, P.A.

Provider Business Mailing Address
First Line	:	410 N JERRY CLOWER BLVD
Second Line	:
City	:	YAZOO CITY
State	:	MS
Zip	:	39194-8274
Country	:	US
Telephone Number	:	662-746-3491
Fax Number	:	662-746-3946

Provider Business Practice Location Address
First Line	:	410 N JERRY CLOWER BLVD
Second Line	:
City	:	YAZOO CITY
State	:	MS
Zip	:	39194-8274
Country	:	US
Telephone Number	:	662-746-3491
Fax Number	:	662-746-3946

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. STASIA D WINFORD
Credential	:	DMD
Telephone Number	:	662-746-3491

Provider Enumeration Date	:	02/08/2012
Last Update Date	:	01/28/2014

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