Provider Demographics
NPI:1609483015
Name:WINNER DENTAL CLINIC, PROF. LLC
Entity Type:Organization
Organization Name:WINNER DENTAL CLINIC, PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-842-1793
Mailing Address - Street 1:911 GOLDEN PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-2176
Mailing Address - Country:US
Mailing Address - Phone:605-842-1793
Mailing Address - Fax:
Practice Address - Street 1:911 GOLDEN PRAIRIE DR
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2176
Practice Address - Country:US
Practice Address - Phone:605-842-1793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental