Provider Demographics
NPI:1407833676
Name:WINTER ENTERPRISES
Entity Type:Organization
Organization Name:WINTER ENTERPRISES
Other - Org Name:SIGNATURE SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUGGEWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-692-5533
Mailing Address - Street 1:PO BOX 1298
Mailing Address - Street 2:120 S 6TH ST
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360
Mailing Address - Country:US
Mailing Address - Phone:856-692-5533
Mailing Address - Fax:856-692-4990
Practice Address - Street 1:120 S 6TH ST
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4605
Practice Address - Country:US
Practice Address - Phone:856-692-5533
Practice Address - Fax:856-692-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1019933261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTIN