Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 11423 | NC |
NPI | 1366001117 |
---|---|
Provider Name | Colin Wint |
First Address | Greenville, NC 27834-5419 |
Second Address | Newland, NC 28657-7604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2019 |
Last Update Date | 06/06/2019 |