Provider Demographics
NPI:1154638484
Name:STACY L. WINCE, DDS INC.
Entity Type:Organization
Organization Name:STACY L. WINCE, DDS INC.
Other - Org Name:WINCE FAMILY DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WINCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-241-0266
Mailing Address - Street 1:1325 E 1ST ST
Mailing Address - Street 2:PO BOX 964
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-3601
Mailing Address - Country:US
Mailing Address - Phone:620-241-0266
Mailing Address - Fax:620-241-6061
Practice Address - Street 1:1325 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-3601
Practice Address - Country:US
Practice Address - Phone:620-241-0266
Practice Address - Fax:620-241-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS602651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty