Provider Demographics
NPI:1770693756
Name:DENTISTRY AT WINBURY INC
Entity type:Organization
Organization Name:DENTISTRY AT WINBURY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCLINTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-543-5020
Mailing Address - Street 1:8401 CHAGRIN ROAD
Mailing Address - Street 2:#11
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023
Mailing Address - Country:US
Mailing Address - Phone:440-543-5020
Mailing Address - Fax:440-543-1344
Practice Address - Street 1:8401 CHAGRIN ROAD
Practice Address - Street 2:#11
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023
Practice Address - Country:US
Practice Address - Phone:440-543-5020
Practice Address - Fax:440-543-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14532122300000X
OH21256122300000X
OH20655122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty