Provider Demographics
NPI:1467575399
Name:WINEBURG, KENNETH GLENN JR (DMD, PA)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:GLENN
Last Name:WINEBURG
Suffix:JR
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3432 E HEBRON PKWY STE 112
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4454
Mailing Address - Country:US
Mailing Address - Phone:972-250-1400
Mailing Address - Fax:972-250-1402
Practice Address - Street 1:3432 E HEBRON PKWY STE 112
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4454
Practice Address - Country:US
Practice Address - Phone:972-250-1400
Practice Address - Fax:972-250-1402
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice