Provider Demographics
NPI:1124647367
Name:VAN WINKLE, EMMA LUCILLE (DMD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:LUCILLE
Last Name:VAN WINKLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5711 ARLINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6203
Mailing Address - Country:US
Mailing Address - Phone:573-870-0314
Mailing Address - Fax:
Practice Address - Street 1:3133 N TOWN EAST BLVD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3920
Practice Address - Country:US
Practice Address - Phone:972-270-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36913122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes122300000XDental ProvidersDentist