Individual provider Active NPI

Marilyn Anita Winningham, DDS

  • Dentist
  • Detroit, MI
National Provider Identifier
1073622882
Registry record updated Dec 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901014926 Issued in MI
Practice address
60 E Warren Ave
Detroit, MI 48201-1312
Phone
(313) 416-6262
Fax
(866) 810-6297
NPI assigned
Aug 29, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 15, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901014926 MI Primary

Addresses

Primary practice location

60 E Warren Ave
Detroit, MI 48201-1312

Mailing address

100 River Place Dr Ste 450
Detroit, MI 48207-5402
Phone (313) 416-6262

Other names 1

  • Marilyn Anita Winningham DDS Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160218001293 MI Order and Referring Only - DentistPractitioner - Dentist 5395040067

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
H2G Dental PLLC PastSince Jan 2, 2022 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1073622882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 RIVER PLACE DR STE 450",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482075402",
            "telephone_number": "313-416-6262",
            "fax_number": "313-221-9681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 E WARREN AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482011312",
            "telephone_number": "313-416-6262",
            "fax_number": "866-810-6297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WINNINGHAM",
        "first_name": "MARILYN",
        "middle_name": "ANITA",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901014926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARILYN",
            "last_name": "WINNINGHAM DDS",
            "middle_name": "ANITA",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.