Healthcare Provider Details

I. General information

NPI: 1770112419
Provider Name (Legal Business Name): CONNIE YOON WINEGAR DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONNIE YOON DDS

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 KENMOOR AVE SE STE 102
GRAND RAPIDS MI
49546-8622
US

IV. Provider business mailing address

655 KENMOOR AVE SE STE 102
GRAND RAPIDS MI
49546-8622
US

V. Phone/Fax

Practice location:
  • Phone: 616-224-3636
  • Fax: 616-224-3644
Mailing address:
  • Phone: 616-224-3636
  • Fax: 616-224-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901602067
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: