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General NPI Number Information
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NPI Number | 1558541474
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Entity Type | Organization
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Legal Business Name | LAWRENCE A WINSE DDS PC
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 2708 N 4TH ST STE F-2
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City | FLAGSTAFF
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State | AZ
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Zip | 86004
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Country | US
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Telephone | 928-526-3810
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Fax | 928-526-1650
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Provider Business Mailing Address
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Address Line | 2708 N 4TH ST STE F-2
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City | FLAGSTAFF
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State | AZ
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Zip | 86004
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Country | US
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Telephone | 928-526-3810
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Fax | 928-526-1650
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAWRENCE ALAN WINSE
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Credential |
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Telephone | 928-526-3810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2401
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License Number State | AZ
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