Provider Demographics
NPI:1407069735
Name:WINTERMANTEL, DAN C (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:C
Last Name:WINTERMANTEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9804 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1228
Mailing Address - Country:US
Mailing Address - Phone:314-968-0550
Mailing Address - Fax:314-968-8705
Practice Address - Street 1:9804 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-1228
Practice Address - Country:US
Practice Address - Phone:314-968-0550
Practice Address - Fax:314-968-8705
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO128221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice