Provider Demographics
NPI:1962993246
Name:TODD J WIND ENTERPRISES LLC
Entity type:Organization
Organization Name:TODD J WIND ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WIND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-843-3300
Mailing Address - Street 1:12818 TESSON FERRY RD STE 2O2
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2945
Mailing Address - Country:US
Mailing Address - Phone:314-843-3300
Mailing Address - Fax:
Practice Address - Street 1:12818 TESSON FERRY RD STE 2O2
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2945
Practice Address - Country:US
Practice Address - Phone:314-843-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001011238122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty