Provider Demographics
NPI:1861515256
Name:WINCHELL, GERALD LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:LYNN
Last Name:WINCHELL
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 1:843 12TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2457
Mailing Address - Country:US
Mailing Address - Phone:360-577-8880
Mailing Address - Fax:360-575-9120
Practice Address - Street 1:843 12TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2457
Practice Address - Country:US
Practice Address - Phone:360-577-8880
Practice Address - Fax:360-575-9120
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist