Basic Information
Provider Information
NPI: 1194769604
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WINTERS
FirstName: DENNIS
MiddleName: DAMIAN
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5546
Address2:  
City: DENVER
State: CO
PostalCode: 802175546
CountryCode: US
TelephoneNumber: 8014753500
FaxNumber:  
Practice Location
Address1: 4403 HARRISON BLVD
Address2: SUITE 1815
City: OGDEN
State: UT
PostalCode: 844033271
CountryCode: US
TelephoneNumber: 8013876520
FaxNumber: 8013876525
Other Information
ProviderEnumerationDate: 06/15/2006
LastUpdateDate: 09/09/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207T00000X6451965-1205UTY Allopathic & Osteopathic PhysiciansNeurological Surgery 

No ID Information.


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