Provider Demographics
NPI:1104177484
Name:WINTER, AMY KATHLEEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:KATHLEEN
Last Name:WINTER
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 1:11532 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-4718
Mailing Address - Country:US
Mailing Address - Phone:425-891-3878
Mailing Address - Fax:
Practice Address - Street 1:120 W DAYTON ST
Practice Address - Street 2:SUITE C-2
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-7217
Practice Address - Country:US
Practice Address - Phone:425-778-7477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60379960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist