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General NPI Number Information
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NPI Number | 1306069034
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Entity Type | Individual
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Provider Name | DAVID WAYNE VANWINKLE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 309 MORROW ST S SUITE A
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City | MENA
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State | AR
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Zip | 71953-2502
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Country | US
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Telephone | 479-394-6596
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Fax | 479-394-6647
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Provider Business Mailing Address
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Address Line | PO BOX 458
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City | MENA
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State | AR
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Zip | 71953-0458
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Country | US
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Telephone | 479-394-6596
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Fax | 479-394-6647
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2836
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License Number State | AR
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