Healthcare Provider Details

I. General information

NPI: 1538868096
Provider Name (Legal Business Name): JOSEPH COLEMAN WINKLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 10/02/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8717 MAIN ST
NEEDVILLE TX
77461-8138
US

IV. Provider business mailing address

8717 MAIN ST
NEEDVILLE TX
77461-8138
US

V. Phone/Fax

Practice location:
  • Phone: 979-793-3366
  • Fax:
Mailing address:
  • Phone: 979-793-3366
  • Fax: 979-793-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39538
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: