Provider Demographics
NPI:1427222074
Name:R D WINLAND DDS INC
Entity Type:Organization
Organization Name:R D WINLAND DDS INC
Other - Org Name:ROGER D. WINLAND DDS INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:WINLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-592-3018
Mailing Address - Street 1:P.O. BOX 140
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-0220
Mailing Address - Country:US
Mailing Address - Phone:740-592-3018
Mailing Address - Fax:740-594-4148
Practice Address - Street 1:715 W. UNION ST.
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-9410
Practice Address - Country:US
Practice Address - Phone:740-592-3018
Practice Address - Fax:740-594-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0246540Medicaid