Provider Demographics
NPI:1487776175
Name:WINN, JEFFREY J (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
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 1:962 E WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-1459
Mailing Address - Country:US
Mailing Address - Phone:262-728-9330
Mailing Address - Fax:262-728-0172
Practice Address - Street 1:962 E WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-1459
Practice Address - Country:US
Practice Address - Phone:262-728-9330
Practice Address - Fax:262-728-0172
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50014071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice