Provider Demographics
NPI:1710158464
Name:JOHN, WINFIELD CLINTON III (DMD)
Entity Type:Individual
Prefix:
First Name:WINFIELD
Middle Name:CLINTON
Last Name:JOHN
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 LEXINGTON AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2873
Mailing Address - Country:US
Mailing Address - Phone:606-329-2219
Mailing Address - Fax:
Practice Address - Street 1:2301 LEXINGTON AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2873
Practice Address - Country:US
Practice Address - Phone:606-329-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43401223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1831292226OtherNPI GROUP #
KY3465OtherPROVIDER GROUP #
KY1831292226OtherNPI GROUP #