Healthcare Provider Details

I. General information

NPI: 1194618520
Provider Name (Legal Business Name): DIANA WINECOFF DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 MARGIE DR
WARNER ROBINS GA
31088-8933
US

IV. Provider business mailing address

134 SOMERSET DR
WARNER ROBINS GA
31088-6331
US

V. Phone/Fax

Practice location:
  • Phone: 478-971-7701
  • Fax:
Mailing address:
  • Phone: 478-952-4695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN123891
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: