Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 3589 | WV |
NPI | 1104091370 |
---|---|
Provider Name | Dr. Johnathon Grant Winkler |
First Address | Beckley, WV 25801 |
Second Address | Beckley, WV 25801-2964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2008 |
Last Update Date | 02/09/2008 |