MEDICARE: BLAKE I WINOKUR DMD P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	10185	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750809091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLAKE I WINOKUR DMD P.C.

Provider Business Mailing Address
First Line	:	53 NORTH ST
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-5637
Country	:	US
Telephone Number	:	12037430783
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 NORTH ST
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-5637
Country	:	US
Telephone Number	:	203-743-0783
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BLAKE WINOKUR
Credential	:	DMD
Telephone Number	:	203-743-0783

Provider Enumeration Date	:	09/07/2017
Last Update Date	:	07/21/2022

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