Provider Demographics
NPI:1629415021
Name:SHIRK, WINFIELD SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:WINFIELD
Middle Name:SCOTT
Last Name:SHIRK
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 1:7931 LAKE ANNA PKWY
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22551-3391
Mailing Address - Country:US
Mailing Address - Phone:540-840-5940
Mailing Address - Fax:
Practice Address - Street 1:11060 SMILE WAY
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-3470
Practice Address - Country:US
Practice Address - Phone:540-775-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-27
Last Update Date:2013-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413995122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist