MEDICARE: DR. MARK ANDREW WINKLER DDS

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	7463	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	792905	OTHER	VA	UNITED CONCORDIA GROUP#

General Provider Information

NPI Number	:	1881783173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ANDREW WINKLER DDS

Provider Business Mailing Address
First Line	:	6116 ROLLING RD
Second Line	:	SUITE 316
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1521
Country	:	US
Telephone Number	:	703-451-8332
Fax Number	:

Provider Business Practice Location Address
First Line	:	6116 ROLLING RD
Second Line	:	SUITE 316
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1521
Country	:	US
Telephone Number	:	703-451-8332
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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