Provider Demographics
NPI:1023107323
Name:WINEBRENNER, ROBERT J (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:WINEBRENNER
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 1:13424 PENNSYLVANIA AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2686
Mailing Address - Country:US
Mailing Address - Phone:301-733-3414
Mailing Address - Fax:301-733-3626
Practice Address - Street 1:322 E ANTIETAM STREET
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740
Practice Address - Country:US
Practice Address - Phone:301-733-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD046591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice