Provider Demographics
NPI:1730480112
Name:RANDALL L. WINTER,D.D.S.,P.C.
Entity type:Organization
Organization Name:RANDALL L. WINTER,D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST-CORP. PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-562-2297
Mailing Address - Street 1:101 FOURTH STREET NW
Mailing Address - Street 2:
Mailing Address - City:BUFFALO CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50424-0355
Mailing Address - Country:US
Mailing Address - Phone:641-562-2297
Mailing Address - Fax:641-562-2267
Practice Address - Street 1:101 4TH ST NW
Practice Address - Street 2:
Practice Address - City:BUFFALO CENTER
Practice Address - State:IA
Practice Address - Zip Code:50424-1055
Practice Address - Country:US
Practice Address - Phone:641-562-2297
Practice Address - Fax:641-562-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06730122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty