Healthcare Provider Details

I. General information

NPI: 1902198294
Provider Name (Legal Business Name): GREGORY DAVID WINTER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W BALTIMORE ST OFC 3215
BALTIMORE MD
21201-1510
US

IV. Provider business mailing address

UNIVERSITY OF MARYLAND SCHOOL OF DENTISTRY 650 W BALTIMORE STREET
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-7060
  • Fax:
Mailing address:
  • Phone: 410-706-7060
  • Fax: 410-706-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number14958
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14958
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: