Provider Demographics
NPI:1821768789
Name:WINN SMILES SHALLOWFORD, PLLC
Entity Type:Organization
Organization Name:WINN SMILES SHALLOWFORD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-310-7424
Mailing Address - Street 1:2217 OLAN MILLS DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1891
Mailing Address - Country:US
Mailing Address - Phone:423-894-5607
Mailing Address - Fax:423-894-7790
Practice Address - Street 1:2217 OLAN MILLS DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1891
Practice Address - Country:US
Practice Address - Phone:423-894-5607
Practice Address - Fax:423-894-7790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty