Provider Demographics
NPI:1184640559
Name:WINTER, MARVIN ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:ROBERT
Last Name:WINTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 CLAIREMONT AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2500
Mailing Address - Country:US
Mailing Address - Phone:404-373-2667
Mailing Address - Fax:404-373-7022
Practice Address - Street 1:160 CLAIREMONT AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2500
Practice Address - Country:US
Practice Address - Phone:404-373-2667
Practice Address - Fax:404-373-7022
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA99911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
182132OtherUNITED CONCORDIA INSUR CO