Healthcare Provider Details

I. General information

NPI: 1770678864
Provider Name (Legal Business Name): DR. RONALD L. WINES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 HAWTHORNE DR
PLAINFIELD IN
46168-1868
US

IV. Provider business mailing address

1635 HAWTHORNE DR
PLAINFIELD IN
46168-1868
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-8191
  • Fax: 317-839-5923
Mailing address:
  • Phone: 317-839-8191
  • Fax: 317-839-5923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7001
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GABRIELLA KWIATKOWSKI
Title or Position: OFFICE
Credential:
Phone: 317-839-8191