Provider Demographics
NPI:1942555610
Name:WINOKUR, JENNA (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:WINOKUR
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5280
Mailing Address - Country:US
Mailing Address - Phone:732-370-3700
Mailing Address - Fax:
Practice Address - Street 1:870 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5280
Practice Address - Country:US
Practice Address - Phone:732-370-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA400075122300000X
NJ22DI025835001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22DI02583500OtherSTATE OF NEW JERSEY, DENTAL BOARD