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General NPI Number Information
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NPI Number | 1356922751
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Entity Type | Individual
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Provider Name | DAVID VAN WINKLE
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Gender | Male
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Dates
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Enumeration Date | 04/16/2021
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 8902 N MERIDIAN ST STE 138
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-5306
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Country | US
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Telephone | 317-844-2792
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Fax |
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Provider Business Mailing Address
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Address Line | 12452 ANCHORAGE WAY
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City | FISHERS
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State | IN
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Zip | 46037-9583
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Country | US
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Telephone | 317-405-7420
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Fax |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 12014507A
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License Number State | IN
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