Provider Demographics
NPI:1295993004
Name:WINKELMAN, PETER A (DDS)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:WINKELMAN
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 1:12114 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5522
Mailing Address - Country:US
Mailing Address - Phone:301-942-5500
Mailing Address - Fax:301-942-5520
Practice Address - Street 1:12114 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-5522
Practice Address - Country:US
Practice Address - Phone:301-942-5500
Practice Address - Fax:301-942-5520
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6519122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD122130764Medicaid