Provider Demographics
NPI:1932360419
Name:WINN, JAMES HOWARD (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HOWARD
Last Name:WINN
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:BOX 576
Mailing Address - Street 2:152 N MAIN ST
Mailing Address - City:MONTICELLO
Mailing Address - State:WI
Mailing Address - Zip Code:53570-0576
Mailing Address - Country:US
Mailing Address - Phone:608-938-4001
Mailing Address - Fax:
Practice Address - Street 1:152 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:WI
Practice Address - Zip Code:53570-0576
Practice Address - Country:US
Practice Address - Phone:608-938-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33395200Medicaid