Provider Demographics
NPI:1609062207
Name:WINTER, SCOTT DONNELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DONNELL
Last Name:WINTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E ORANGEBURG AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5578
Mailing Address - Country:US
Mailing Address - Phone:209-577-4616
Mailing Address - Fax:
Practice Address - Street 1:501 E ORANGEBURG AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5578
Practice Address - Country:US
Practice Address - Phone:209-577-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice