Provider Demographics
NPI:1912050550
Name:DIKE, WINIFRED O (DDS)
Entity Type:Individual
Prefix:
First Name:WINIFRED
Middle Name:O
Last Name:DIKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 S BRAESWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-1301
Mailing Address - Country:US
Mailing Address - Phone:713-777-3368
Mailing Address - Fax:713-777-3370
Practice Address - Street 1:8614 S BRAESWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-1301
Practice Address - Country:US
Practice Address - Phone:713-777-3368
Practice Address - Fax:713-777-3370
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166416108Medicaid