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NPI Code Detail

MEDICARE: DR. KEITH CLARENCE WINTERNHEIMER DDS

MEDICARE: DR. KEITH CLARENCE WINTERNHEIMER DDS
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
1122300000XDentist019024049IL

General Provider Information

NPI Number : 1700221074
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEITH CLARENCE WINTERNHEIMER DDS
Provider Business Mailing Address
First Line : 610 NORTH COURT
Second Line :
City : GRAYVILLE
State : IL
Zip : 62844-1002
Country : US
Telephone Number : 618-375-6341
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 :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2013
Last Update Date : 05/01/2013

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