Organization
JACK T WINCHESTER DMD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK TYLER WINCHESTER DMD (OWNER)
(252) 247-3510
Entity
Organization
Contact information
Practice address
3705 SYMI CIR, MOREHEAD CITY, NC 28557-4314
(252) 247-3510
(252) 247-6197
Mailing address
3705 SYMI CIR, MOREHEAD CITY, NC 28557-4314
(252) 247-3510
(252) 247-6197
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5372
NC
332BC3200X
Customized Equipment (DME)
5372
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2417497
MEDICARE
—
Enumeration date
02/07/2011
Last updated
02/07/2011
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