Provider Demographics
NPI:1396125902
Name:WINHEIM, MATTHEW (DDS, MPH)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:WINHEIM
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 QUARRY LAKE DR
Mailing Address - Street 2:APT 302
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4206 QUARRY LAKE DR
Practice Address - Street 2:APT 302
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-7111
Practice Address - Country:US
Practice Address - Phone:540-998-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414870122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist