DR. Michael J Wine, DDS

NPI #1245353168 in Jackson, Wyoming

Provider Information

NPI Number: 1245353168
Entity Type: Individual
Name: DR. Michael J Wine, DDS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DDS
Enumeration Date: Apr 7, 2007
Last Updated: Sep 1, 2016

Practice Location

Address: 610 W BROADWAY AVE
City: Jackson
State: Wyoming
ZIP Code: 83001-8213
Phone: (307) 732-2273

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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