Healthcare Provider Details

I. General information

NPI: 1548990633
Provider Name (Legal Business Name): WILLIAM SKYLER WINSOR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 08/27/2023
Certification Date: 08/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 DG-AF POSTGRADUATE DENTAL SCHOOL 2133 PEPPERRELL ST, BLDG 3352
APO AA
78236-5313
US

IV. Provider business mailing address

2180 REESE ST BLDG 1285 PO BOX 140
LACKLAND AFB TX
78236-2166
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-6258
  • Fax: 210-292-2618
Mailing address:
  • Phone: 512-713-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number39033
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number39033
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: