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General NPI Number Information
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NPI Number | 1790032282
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Entity Type | Organization
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Legal Business Name | WINN FAMILY DENTISTRY
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 2849 COUNTY HIGHWAY I
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-2656
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Country | US
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Telephone | 715-723-0287
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Fax |
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Provider Business Mailing Address
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Address Line | 2849 COUNTY HIGHWAY I
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-2656
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Country | US
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Telephone | 715-723-0287
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DANIEL JAMES WINN
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Credential | D.D.S.
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Telephone | 715-723-0287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6264-015
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License Number State | WI
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