Healthcare Provider Details

I. General information

NPI: 1154638484
Provider Name (Legal Business Name): STACY L. WINCE, DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E 1ST ST
MCPHERSON KS
67460-3601
US

IV. Provider business mailing address

1325 E 1ST ST PO BOX 964
MCPHERSON KS
67460-3601
US

V. Phone/Fax

Practice location:
  • Phone: 620-241-0266
  • Fax: 620-241-6061
Mailing address:
  • Phone: 620-241-0266
  • Fax: 620-241-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60265
License Number StateKS

VIII. Authorized Official

Name: DR. STACY LEE WINCE
Title or Position: PRESIDENT
Credential: DDS
Phone: 620-241-0266