Provider Demographics
NPI:1861675597
Name:THOMAS LEE WINEGARDEN
Entity Type:Organization
Organization Name:THOMAS LEE WINEGARDEN
Other - Org Name:A BEAUTIFUL SMILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WINEGARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-447-3020
Mailing Address - Street 1:6767 N FRESNO ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-3709
Mailing Address - Country:US
Mailing Address - Phone:559-447-3020
Mailing Address - Fax:559-447-3025
Practice Address - Street 1:6767 N FRESNO ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3709
Practice Address - Country:US
Practice Address - Phone:559-447-3020
Practice Address - Fax:559-447-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29905122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty