Healthcare Provider Details

I. General information

NPI: 1417126459
Provider Name (Legal Business Name): DESIREE WINTERHALTER, D.M.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 DARTMOUTH ST
SOUTH DARTMOUTH MA
02748-2516
US

IV. Provider business mailing address

609 DARTMOUTH ST
SOUTH DARTMOUTH MA
02748-2516
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-0922
  • Fax: 508-997-4487
Mailing address:
  • Phone: 508-996-0922
  • Fax: 508-997-4487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18140
License Number StateMA

VIII. Authorized Official

Name: JILL RAINVILLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 508-996-0922