Organization Name: | JACK T WINCHESTER DMD |
NPI Number: | 1154627230 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JACK TYLER WINCHESTER (OWNER) |
Mailing Address: | 3705 Symi Cir Morehead City |
State: | NC US |
Postal Code: | 285574314 |
Phone Number: | 2522473510 |
Fax Number: | 2522476197 |
NPI Enumeration Date: | 02/07/2011 |
NPI Last Update Date: | 02/07/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BC3200X |
License Number: | 5372 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Customized Equipment |
Taxonomy Definition: |