Individual
DR. MICHAEL J WINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
610 W BROADWAY AVE, JACKSON, WY 83001-8213
(307) 732-2273
(307) 732-1660
Mailing address
6797 SHIRE RIDGE DR, VICTOR, ID 83455-5036
(614) 648-6657
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1325
WY
122300000X
Dentist
D 4424
ID
Other
Enumeration date
04/07/2007
Last updated
09/01/2016
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