Provider Demographics
NPI:1376542928
Name:WINDER, RONALD LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LYNN
Last Name:WINDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5602 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-9016
Mailing Address - Country:US
Mailing Address - Phone:918-664-9797
Mailing Address - Fax:918-664-1666
Practice Address - Street 1:5602 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9016
Practice Address - Country:US
Practice Address - Phone:918-664-9797
Practice Address - Fax:918-664-1666
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36201223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK013754Medicare UPIN