Provider Demographics
NPI:1194264408
Name:WINSTED DENTAL PLLC
Entity type:Organization
Organization Name:WINSTED DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANDSTEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-275-2954
Mailing Address - Street 1:430 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DASSEL
Mailing Address - State:MN
Mailing Address - Zip Code:55325
Mailing Address - Country:US
Mailing Address - Phone:320-275-2954
Mailing Address - Fax:320-275-5004
Practice Address - Street 1:430 2ND ST
Practice Address - Street 2:
Practice Address - City:DASSEL
Practice Address - State:MN
Practice Address - Zip Code:55325
Practice Address - Country:US
Practice Address - Phone:320-275-2954
Practice Address - Fax:320-275-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental