Provider Demographics
NPI:1144621236
Name:WINSLOW, MARK SAMPSON II (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SAMPSON
Last Name:WINSLOW
Suffix:II
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 1:365 PEARSON DR
Mailing Address - Street 2:SUITE #2
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3360
Mailing Address - Country:US
Mailing Address - Phone:808-284-2746
Mailing Address - Fax:
Practice Address - Street 1:365 PEARSON DR
Practice Address - Street 2:SUITE #2
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3360
Practice Address - Country:US
Practice Address - Phone:808-284-2746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist