Provider Demographics
NPI:1619242328
Name:WINEGAR, DAVID ALLEN (DDS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:WINEGAR
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 1:255 W HIGHWAY 210 STE 1
Mailing Address - Street 2:
Mailing Address - City:MCGREGOR
Mailing Address - State:MN
Mailing Address - Zip Code:55760-5004
Mailing Address - Country:US
Mailing Address - Phone:218-768-4111
Mailing Address - Fax:218-768-3600
Practice Address - Street 1:255 W HIGHWAY 210 STE 1
Practice Address - Street 2:
Practice Address - City:MCGREGOR
Practice Address - State:MN
Practice Address - Zip Code:55760-5004
Practice Address - Country:US
Practice Address - Phone:218-768-4111
Practice Address - Fax:218-768-3600
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND9340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN570020500Medicaid