Provider Demographics
NPI:1841333176
Name:WINTERS, JACK RUTLEDGE (DDS)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:RUTLEDGE
Last Name:WINTERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 N PEARL STREET
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406
Mailing Address - Country:US
Mailing Address - Phone:253-756-1600
Mailing Address - Fax:253-756-1668
Practice Address - Street 1:2102 N PEARL STREET
Practice Address - Street 2:SUITE 206
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406
Practice Address - Country:US
Practice Address - Phone:253-756-1600
Practice Address - Fax:253-756-1668
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000060801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice