Provider Demographics
NPI:1144583386
Name:DISTINCTIVE DENTISTRY P.C.
Entity Type:Organization
Organization Name:DISTINCTIVE DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:C
Authorized Official - Last Name:WINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-476-9371
Mailing Address - Street 1:475 IRVING AVENUE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-476-9371
Mailing Address - Fax:315-475-8097
Practice Address - Street 1:475 IRVING AVENUE
Practice Address - Street 2:SUITE 404
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-476-9371
Practice Address - Fax:315-475-8097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty