Provider Demographics
NPI:1710044144
Name:KENNETH R WINOKUR DMD PC
Entity Type:Organization
Organization Name:KENNETH R WINOKUR DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:WINOKUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-838-1633
Mailing Address - Street 1:329 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351
Mailing Address - Country:US
Mailing Address - Phone:503-838-1633
Mailing Address - Fax:503-838-4640
Practice Address - Street 1:329 S MAIN ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351
Practice Address - Country:US
Practice Address - Phone:503-838-1633
Practice Address - Fax:503-838-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6210122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty