Healthcare Provider Details

I. General information

NPI: 1114230125
Provider Name (Legal Business Name): MICHAEL GRANT WINKELMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5270 W BASELINE RD STE 130
LAVEEN AZ
85339-6959
US

IV. Provider business mailing address

4123 W VALLEY VIEW DR
LAVEEN AZ
85339-7856
US

V. Phone/Fax

Practice location:
  • Phone: 160-234-6988
  • Fax:
Mailing address:
  • Phone: 503-380-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD008594
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: