Provider Demographics
NPI:1912477209
Name:ERIC WINTERTON DDS LLC
Entity Type:Organization
Organization Name:ERIC WINTERTON DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-987-2705
Mailing Address - Street 1:705 MAIN ST SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8308
Mailing Address - Country:US
Mailing Address - Phone:505-865-3395
Mailing Address - Fax:505-865-1414
Practice Address - Street 1:705 MAIN ST SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8308
Practice Address - Country:US
Practice Address - Phone:505-865-3395
Practice Address - Fax:505-865-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental