Provider Demographics
NPI:1205451523
Name:WINTER, BRANDON (DDS)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
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 1:314 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4436
Mailing Address - Country:US
Mailing Address - Phone:563-242-5041
Mailing Address - Fax:563-242-5044
Practice Address - Street 1:314 3RD AVE S
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4436
Practice Address - Country:US
Practice Address - Phone:563-242-5041
Practice Address - Fax:563-242-5044
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-097701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice