Provider Demographics
NPI:1538220520
Name:WINN, GERARD E (DDS)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:E
Last Name:WINN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 VAN DEENE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089
Mailing Address - Country:US
Mailing Address - Phone:413-788-9621
Mailing Address - Fax:413-788-0103
Practice Address - Street 1:75 VAN DEENE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089
Practice Address - Country:US
Practice Address - Phone:413-788-9621
Practice Address - Fax:413-788-0103
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA132071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
X04075Medicare ID - Type Unspecified
T89669Medicare UPIN