Provider Demographics
NPI:1922084292
Name:WINKER, WADE GARY (DDS)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:GARY
Last Name:WINKER
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 1:15 W ATWATER AVE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-5401
Mailing Address - Country:US
Mailing Address - Phone:352-357-2564
Mailing Address - Fax:352-357-0778
Practice Address - Street 1:15 W ATWATER AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-5401
Practice Address - Country:US
Practice Address - Phone:352-357-2564
Practice Address - Fax:352-357-0778
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012573122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist