Provider Demographics
NPI:1073622882
Name:WINNINGHAM, MARILYN ANITA (DDS)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:ANITA
Last Name:WINNINGHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:ANITA
Other - Last Name:WINNINGHAM DDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:100 RIVER PLACE DR STE 450
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-5402
Mailing Address - Country:US
Mailing Address - Phone:313-416-6262
Mailing Address - Fax:313-221-9681
Practice Address - Street 1:60 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1312
Practice Address - Country:US
Practice Address - Phone:313-416-6262
Practice Address - Fax:866-810-6297
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist