Healthcare Provider Details

I. General information

NPI: 1861832834
Provider Name (Legal Business Name): CODY WARNER WINTERHOLLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2013
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 SE 4TH ST WINTERHOLLER DENTISTRY
LAUREL MT
59044-3317
US

IV. Provider business mailing address

2143 LARCHWOOD LN
BILLINGS MT
59106-4741
US

V. Phone/Fax

Practice location:
  • Phone: 406-628-4500
  • Fax:
Mailing address:
  • Phone: 406-672-0224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7111
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number09076
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9555
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: