Provider Demographics
NPI:1306069034
Name:VANWINKLE, DAVID WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WAYNE
Last Name:VANWINKLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-0458
Mailing Address - Country:US
Mailing Address - Phone:479-394-6596
Mailing Address - Fax:479-394-6647
Practice Address - Street 1:309 MORROW ST S
Practice Address - Street 2:SUITE A
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-2502
Practice Address - Country:US
Practice Address - Phone:479-394-6596
Practice Address - Fax:479-394-6647
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR855971OtherUNITED CONCORDIA
AR58062OtherBLUE CROSS BLUE SHIELD