Provider Demographics
NPI:1083888606
Name:TODD J. WIND D.D.S. P.C.
Entity Type:Organization
Organization Name:TODD J. WIND D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WIND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-843-2078
Mailing Address - Street 1:12109 TESSON FERRY PROFESSIONAL CTR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1250
Mailing Address - Country:US
Mailing Address - Phone:314-843-2078
Mailing Address - Fax:
Practice Address - Street 1:12109 TESSON FERRY PROFESSIONAL CTR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1250
Practice Address - Country:US
Practice Address - Phone:314-843-2078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2001011238OtherDELTA DENTAL