Provider Demographics
NPI:1578957395
Name:WINGO FAMILY DENTISTRY
Entity Type:Organization
Organization Name:WINGO FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:WINGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-876-2325
Mailing Address - Street 1:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:JOELTON
Mailing Address - State:TN
Mailing Address - Zip Code:37080-0759
Mailing Address - Country:US
Mailing Address - Phone:615-876-2325
Mailing Address - Fax:615-876-2325
Practice Address - Street 1:3353B UNION HILL RD
Practice Address - Street 2:
Practice Address - City:JOELTON
Practice Address - State:TN
Practice Address - Zip Code:37080-8726
Practice Address - Country:US
Practice Address - Phone:615-876-2325
Practice Address - Fax:615-876-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty