Healthcare Provider Details

I. General information

NPI: 1194829101
Provider Name (Legal Business Name): DR JOHN S WINGFIELD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 WEST HAVENS ST
MITCHELL SD
57301-0490
US

IV. Provider business mailing address

PO BOX 490
MITCHELL SD
57301-0490
US

V. Phone/Fax

Practice location:
  • Phone: 605-996-6211
  • Fax: 605-996-6213
Mailing address:
  • Phone: 605-996-6211
  • Fax: 605-996-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberM252
License Number StateSD

VII. Legacy identifiers

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

# 1
Identifier7800570
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: DR. JOHN STUART WINGFIELD
Title or Position: OWNER PRESIDENT
Credential: DDS
Phone: 605-996-6211