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NPI Code Detail

MEDICARE: KEITH C WINTERNHEIMER DDS PC

MEDICARE: KEITH C WINTERNHEIMER DDS PC
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
1122300000XDentist12009321AIN
2122300000XDentist019024049IL

General Provider Information

NPI Number : 1477645216
Entity Type Code : Organization
Provider Name (Legal Business Name) : KEITH C WINTERNHEIMER DDS PC
Provider Business Mailing Address
First Line : 4301 S POSEY COUNTY LINE ROAD
Second Line :
City : EVANSVILLE
State : IN
Zip : 47712-9301
Country : US
Telephone Number : 812-985-7772
Fax Number :
Provider Business Practice Location Address
First Line : 610 NORTH COURT
Second Line :
City : GRAYVILLE
State : IL
Zip : 62844-1002
Country : US
Telephone Number : 618-375-6341
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. KEITH CLARENCE WINTERNHEIMER
Credential : DDS
Telephone Number : 812-985-7772
Provider Enumeration Date : 09/29/2006
Last Update Date : 01/18/2013

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