Provider Demographics
NPI:1477645216
Name:KEITH C WINTERNHEIMER DDS PC
Entity Type:Organization
Organization Name:KEITH C WINTERNHEIMER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:CLARENCE
Authorized Official - Last Name:WINTERNHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-985-7772
Mailing Address - Street 1:4301 S POSEY COUNTY LINE ROAD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-9301
Mailing Address - Country:US
Mailing Address - Phone:812-985-7772
Mailing Address - Fax:
Practice Address - Street 1:610 NORTH COURT
Practice Address - Street 2:
Practice Address - City:GRAYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62844-1002
Practice Address - Country:US
Practice Address - Phone:618-375-6341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009321A122300000X
IL019024049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty