Provider Demographics
NPI:1063632651
Name:WINCHESTER, DONNA SUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:SUE
Last Name:WINCHESTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W LUBBOCK ST
Mailing Address - Street 2:
Mailing Address - City:SLATON
Mailing Address - State:TX
Mailing Address - Zip Code:79364-4131
Mailing Address - Country:US
Mailing Address - Phone:806-828-5873
Mailing Address - Fax:806-828-5871
Practice Address - Street 1:105 W LUBBOCK ST
Practice Address - Street 2:
Practice Address - City:SLATON
Practice Address - State:TX
Practice Address - Zip Code:79364-4131
Practice Address - Country:US
Practice Address - Phone:806-828-5873
Practice Address - Fax:806-828-5871
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice