MEDICARE: DR. JAMES RONALD WINCHESTER 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
1	122300000X	Dentist	GA11352	GA

General Provider Information

NPI Number	:	1578746319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES RONALD WINCHESTER DDS, PC

Provider Business Mailing Address
First Line	:	5815 MOON RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-3836
Country	:	US
Telephone Number	:	706-563-6027
Fax Number	:

Provider Business Practice Location Address
First Line	:	5815 MOON RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-3836
Country	:	US
Telephone Number	:	706-563-6027
Fax Number	:

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

Provider Enumeration Date	:	12/17/2007
Last Update Date	:	12/17/2007

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