Healthcare Provider Details

I. General information

NPI: 1225685183
Provider Name (Legal Business Name): JONATHAN MICHAEL WINFIELD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2019
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 W FULLERTON AVE UNIT C106
CHICAGO IL
60707-3439
US

IV. Provider business mailing address

905 1/2 CREST RD
DEL MAR CA
92014-2617
US

V. Phone/Fax

Practice location:
  • Phone: 773-385-6700
  • Fax:
Mailing address:
  • Phone: 858-213-4856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.032358
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDDS108485
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberS5-60C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: