Provider Demographics
NPI:1427613819
Name:DINKINS, TANZANIA
Entity type:Individual
Prefix:
First Name:TANZANIA
Middle Name:
Last Name:DINKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 BROMLEY TER APT 302
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5054
Mailing Address - Country:US
Mailing Address - Phone:336-995-1056
Mailing Address - Fax:
Practice Address - Street 1:1136 E CLEMMONSVILLE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-4226
Practice Address - Country:US
Practice Address - Phone:336-995-1056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier