Healthcare Provider Details

I. General information

NPI: 1356557136
Provider Name (Legal Business Name): DORSAY LEROY WINTHERS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 NORTH KIMBALL
MITCHELL SD
57301
US

IV. Provider business mailing address

1920 NORTH KIMBALL
MITCHELL SD
57301
US

V. Phone/Fax

Practice location:
  • Phone: 605-996-7786
  • Fax: 605-996-5895
Mailing address:
  • Phone: 605-996-7786
  • Fax: 605-996-5895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberM379
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7800550
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: