MEDICARE: WINIFRED O. DIKE, DDS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	21637	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000272850	OTHER		CARRINGTON PPO
2	B2163701	OTHER	TX	CHIPS

General Provider Information

NPI Number	:	1457406647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINIFRED O. DIKE, DDS PA

Provider Business Mailing Address
First Line	:	8614 S BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-1301
Country	:	US
Telephone Number	:	713-777-3368
Fax Number	:	713-777-3370

Provider Business Practice Location Address
First Line	:	8614 S BRAESWOOD BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-1301
Country	:	US
Telephone Number	:	713-777-3368
Fax Number	:	713-777-3370

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. WINIFRED O DIKE
Credential	:	DDS
Telephone Number	:	713-777-3368

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	08/22/2020

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