Provider Demographics
NPI:1427171818
Name:G.L. WINCHELL D.D.S., P.S.
Entity type:Organization
Organization Name:G.L. WINCHELL D.D.S., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WINCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-577-8880
Mailing Address - Street 1:843 12TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2457
Mailing Address - Country:US
Mailing Address - Phone:360-577-8880
Mailing Address - Fax:360-575-9120
Practice Address - Street 1:843 12TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2457
Practice Address - Country:US
Practice Address - Phone:360-577-8880
Practice Address - Fax:360-575-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004996261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental