MEDICARE: DR. RONALD LYNN WINDER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	3620	OK

General Provider Information

NPI Number	:	1376542928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD LYNN WINDER D.D.S.

Provider Business Mailing Address
First Line	:	5602 S MEMORIAL DR
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-9016
Country	:	US
Telephone Number	:	918-664-9797
Fax Number	:	918-664-1666

Provider Business Practice Location Address
First Line	:	5602 S MEMORIAL DR
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-9016
Country	:	US
Telephone Number	:	918-664-9797
Fax Number	:	918-664-1666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2005
Last Update Date	:	07/09/2007

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