Healthcare Provider Details

I. General information

NPI: 1871526566
Provider Name (Legal Business Name): KATHERINE WINTER LETA VIG BDS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 12TH AVE
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

1350 SHERBORNE LN
POWELL OH
43065-7603
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-5972
  • Fax: 614-688-3077
Mailing address:
  • Phone: 614-436-7755
  • Fax: 614-436-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20189
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: