Provider Demographics
NPI:1275688426
Name:WINER, MARTIN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:J
Last Name:WINER
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 1:215 N OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4911
Mailing Address - Country:US
Mailing Address - Phone:310-275-7215
Mailing Address - Fax:
Practice Address - Street 1:3932 WILSHIRE BLVE SUITE 100
Practice Address - Street 2:WILSHIRE CENTER DENTAL GROUP
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010
Practice Address - Country:US
Practice Address - Phone:213-386-3336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice