Active NPI
David Wayne Vanwinkle, D.D.S.
- Dentist
- Mena, AR
National Provider Identifier
1306069034
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(2) exclusion effective Feb 19, 2015.
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2836
- Practice address
- 309 Morrow St S
Suite a
Mena, AR 71953-2502 - Phone
- (479) 394-6596
- Fax
- (479) 394-6647
- NPI assigned
- Apr 11, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2836 | AR | Primary |
Addresses
Primary practice location
309 Morrow St S
Suite a
Mena, AR 71953-2502
Mailing address
PO Box 458
Mena, AR 71953-0458
Phone (479) 394-6596
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 855971 | Other | AR | UNITED CONCORDIA |
| 58062 | Other | AR | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2836 | AR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190764800000",
"number": "1306069034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 458",
"city": "MENA",
"state": "AR",
"postal_code": "719530458",
"telephone_number": "479-394-6596",
"fax_number": "479-394-6647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "309 MORROW ST S",
"address_2": "SUITE A",
"city": "MENA",
"state": "AR",
"postal_code": "719532502",
"telephone_number": "479-394-6596",
"fax_number": "479-394-6647"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANWINKLE",
"first_name": "DAVID",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-11",
"last_updated": "2007-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AR",
"license": "2836",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "855971",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "58062",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mena, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.