Provider Demographics
NPI:1740374453
Name:WINEGARDEN, THOMAS LEE
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LEE
Last Name:WINEGARDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21281 LOPER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PRATHER
Mailing Address - State:CA
Mailing Address - Zip Code:93651-9616
Mailing Address - Country:US
Mailing Address - Phone:559-285-2510
Mailing Address - Fax:
Practice Address - Street 1:6767 N FRESNO ST STE 200
Practice Address - Street 2:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice