Provider Demographics
NPI:1033317458
Name:WINTER PARK DENTISTRY, P.A.
Entity type:Organization
Organization Name:WINTER PARK DENTISTRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:316-722-2166
Mailing Address - Street 1:1445 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-2985
Mailing Address - Country:US
Mailing Address - Phone:316-722-2166
Mailing Address - Fax:316-722-0949
Practice Address - Street 1:1445 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2985
Practice Address - Country:US
Practice Address - Phone:316-722-2166
Practice Address - Fax:316-722-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS 5342261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS97-4395OtherUNITED CONCORDIA
KS08-328OtherBLUE CROSS BLUE SHIELD