Provider Demographics
NPI:1689764136
Name:WINKLE, MATTHEW R (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:WINKLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:REDWOODS RURAL HEALTH CLINIC
Mailing Address - City:REDWAY
Mailing Address - State:CA
Mailing Address - Zip Code:95560-0769
Mailing Address - Country:US
Mailing Address - Phone:707-923-2783
Mailing Address - Fax:707-923-1688
Practice Address - Street 1:101 WEST COAST ROAD
Practice Address - Street 2:REDWOODS RURAL HEALTH CENTER
Practice Address - City:REDWAY
Practice Address - State:CA
Practice Address - Zip Code:95560
Practice Address - Country:US
Practice Address - Phone:707-923-2783
Practice Address - Fax:707-923-1688
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8627122300000X
CA60013122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist