Provider Demographics
NPI:1811054414
Name:WINTERS, FRED G (DDS)
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:G
Last Name:WINTERS
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:OKEENE
Mailing Address - State:OK
Mailing Address - Zip Code:73763
Mailing Address - Country:US
Mailing Address - Phone:580-822-3266
Mailing Address - Fax:580-822-3927
Practice Address - Street 1:1741 W 33RD ST STE 100
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3838
Practice Address - Country:US
Practice Address - Phone:405-657-2127
Practice Address - Fax:580-822-3927
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist