=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114448388
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIANE MARIE HERDER WINTERS DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2017
-----------------------------------------------------
Last Update Date | 08/22/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 HICKMAN RD. BROADLAWNS MEDICAL CENTER DENTAL CLINIC
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-208-3792
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 HICKMAN ROAD
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-282-2421
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DDS-09428
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------