Healthcare Provider Details

I. General information

NPI: 1760788806
Provider Name (Legal Business Name): ELIZABETH MARIE WINEGAR D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W MAIN ST
FARWELL MI
48622-8753
US

IV. Provider business mailing address

2525 E WHIPPOORWILL HOLW
MIDLAND MI
48642-7876
US

V. Phone/Fax

Practice location:
  • Phone: 989-588-4121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901020332
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: