1114448388 NPI number — DR. JULIANE MARIE HERDER WINTERS DDS

Table of content: DR. JULIANE MARIE HERDER WINTERS DDS (NPI 1114448388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114448388 NPI number — DR. JULIANE MARIE HERDER WINTERS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINTERS
Provider First Name:
JULIANE
Provider Middle Name:
MARIE HERDER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114448388
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 HICKMAN ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-282-2421
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 HICKMAN RD.
Provider Second Line Business Practice Location Address:
BROADLAWNS MEDICAL CENTER DENTAL CLINIC
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-208-3792
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DDS-09428 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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