Provider Demographics
NPI:1174645303
Name:CO, WINSTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:WINSTON
Middle Name:
Last Name:CO
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 1:6609 QUEEN ANNE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2781
Mailing Address - Country:US
Mailing Address - Phone:248-960-3687
Mailing Address - Fax:
Practice Address - Street 1:1308 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2817
Practice Address - Country:US
Practice Address - Phone:313-561-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0156701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3128038Medicare ID - Type UnspecifiedTYPE 12