NPIMap

Organization Active NPI

Jack T Winchester DMD

  • Dentist
  • Morehead City, NC
National Provider Identifier
1154627230
Registry record updated Feb 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5372 Issued in NC
Legal business name
JACK T WINCHESTER DMD
Practice address
3705 Symi Cir
Morehead City, NC 28557-4314
Phone
(252) 247-3510
Fax
(252) 247-6197
NPI assigned
Feb 7, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jack Tyler Winchester, DMD
Title
Owner
Phone
(252) 247-3510

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 5372 NC Primary
Customized Equipment (DME) 332BC3200X 5372 NC

Addresses

Primary practice location

3705 Symi Cir
Morehead City, NC 28557-4314

Mailing address

3705 Symi Cir
Morehead City, NC 28557-4314
Phone (252) 247-3510

Other identifiers 1

IdentifierTypeStateIssuer
2417497OtherMEDICARE

National Provider Directory

National Provider Directory
Tax ID family
Comprehensive Dental Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297036800000",
    "number": "1154627230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3705 SYMI CIR",
            "city": "MOREHEAD CITY",
            "state": "NC",
            "postal_code": "285574314",
            "telephone_number": "252-247-3510",
            "fax_number": "252-247-6197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3705 SYMI CIR",
            "city": "MOREHEAD CITY",
            "state": "NC",
            "postal_code": "285574314",
            "telephone_number": "252-247-3510",
            "fax_number": "252-247-6197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK T WINCHESTER DMD",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-07",
        "last_updated": "2011-02-07",
        "status": "A",
        "authorized_official_last_name": "WINCHESTER",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "TYLER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-247-3510",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "5372",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NC",
            "license": "5372",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "2417497",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morehead City, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.