Provider Demographics
NPI:1679567374
Name:WINTER, LEANN MARIE (DDS)
Entity type:Individual
Prefix:MRS
First Name:LEANN
Middle Name:MARIE
Last Name:WINTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 37TH ST
Mailing Address - Street 2:FLOOR 3
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-5060
Mailing Address - Country:US
Mailing Address - Phone:425-252-3283
Mailing Address - Fax:425-259-8149
Practice Address - Street 1:1823 37TH ST
Practice Address - Street 2:FLOOR 3
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-5060
Practice Address - Country:US
Practice Address - Phone:425-252-3283
Practice Address - Fax:425-259-8149
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA67571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5013875Medicaid