NPI 1245353168
Michael J Wine, DDS
Practice location
- Address
- 610 W Broadway Ave, Jackson, WY 83001-8213
- Phone
- (307) 732-2273
- Fax
- (307) 732-1660
- Mailing address
- 6797 Shire Ridge Dr, Victor, ID 83455-5036
Registered specialties (2)
Dentist
Primary
Dentist
Registry record
- NPI
- 1245353168
- Entity type
- Individual
- Sex (as registered)
- Male
- NPI issued
- 7 Apr 2007
- Record last updated
- 1 Sep 2016
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.