Provider Demographics
NPI:1861535759
Name:WINN SMILES CLEVELAND
Entity type:Organization
Organization Name:WINN SMILES CLEVELAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-472-6482
Mailing Address - Street 1:120 23RD ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3845
Mailing Address - Country:US
Mailing Address - Phone:423-472-6482
Mailing Address - Fax:
Practice Address - Street 1:120 23RD ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3845
Practice Address - Country:US
Practice Address - Phone:423-472-6482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8088122300000X
TN7761122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4062753OtherOUR BCBS PROVIDER ID #