Provider Demographics
NPI:1093177040
Name:WINTERS, JANETTE ROSE (RDH, BSDH)
Entity Type:Individual
Prefix:
First Name:JANETTE
Middle Name:ROSE
Last Name:WINTERS
Suffix:
Gender:F
Credentials:RDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57418 CR 681
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49057
Mailing Address - Country:US
Mailing Address - Phone:269-621-5159
Mailing Address - Fax:269-427-5180
Practice Address - Street 1:57418 CR 681
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:MI
Practice Address - Zip Code:49057
Practice Address - Country:US
Practice Address - Phone:269-621-6259
Practice Address - Fax:269-927-5493
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902013554124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist