Healthcare Provider Details

I. General information

NPI: 1932943487
Provider Name (Legal Business Name): LAUREN BRYANNA WINTERHALTER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8481 VIRGINIA DR
WESTFIELD CENTER OH
44251-9761
US

IV. Provider business mailing address

18091 CLIFTON RD
LAKEWOOD OH
44107-1022
US

V. Phone/Fax

Practice location:
  • Phone: 330-887-1777
  • Fax:
Mailing address:
  • Phone: 216-338-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.027539
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: