Provider Demographics
NPI:1114230125
Name:WINKELMAN, MICHAEL GRANT (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GRANT
Last Name:WINKELMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7342 E JUNE ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-2957
Mailing Address - Country:US
Mailing Address - Phone:503-380-1194
Mailing Address - Fax:
Practice Address - Street 1:3061 W APACHE TRL
Practice Address - Street 2:1
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-3623
Practice Address - Country:US
Practice Address - Phone:480-671-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKDEN D 13471223G0001X
AZ85941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice