Healthcare Provider Details

I. General information

NPI: 1326148925
Provider Name (Legal Business Name): STACY L WINCE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 09/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E. 1ST ST.
MCPHERSON KS
67460
US

IV. Provider business mailing address

1325 E. 1ST ST. PO BOX 964
MCPHERSON KS
67460
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:
Title or Position:
Credential:
Phone: