Provider Demographics
NPI:1063413722
Name:WINDELL, HENRY COOKE (DMD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:COOKE
Last Name:WINDELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24850 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8317
Mailing Address - Country:US
Mailing Address - Phone:503-665-7882
Mailing Address - Fax:503-665-6983
Practice Address - Street 1:24850 SE STARK ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8316
Practice Address - Country:US
Practice Address - Phone:503-665-7882
Practice Address - Fax:503-665-6983
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD42831223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR104416Medicare ID - Type Unspecified
ORT68273Medicare UPIN