Provider Demographics
NPI:1881698140
Name:WINN, PAUL J (DDS, PC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:WINN
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 SHAWNEE DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-5332
Mailing Address - Country:US
Mailing Address - Phone:616-241-2774
Mailing Address - Fax:
Practice Address - Street 1:4095 PARK EAST CT SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8299
Practice Address - Country:US
Practice Address - Phone:616-956-8995
Practice Address - Fax:616-949-2096
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0160981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice