MICHAEL J WINE

JACKSON, WY
NPI1245353168
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy122300000X Dentist
(Licence: WY  1325)
Additional Taxonomies122300000X Dentist
(Licence: ID  D 4424)
Enumeration Date2007-04-07
Last Update Date2016-09-01
Business Address
Dr. MICHAEL J WINE DDS
610 W BROADWAY AVE
JACKSON, WY 83001-8213
Phone number: 307-732-2273
Mailing Address
Dr. MICHAEL J WINE DDS
6797 SHIRE RIDGE DR
VICTOR, ID 83455-5036
Phone number: 614-648-6657
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