Provider Demographics
NPI:1255495875
Name:WINSTON, JO ELLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JO
Middle Name:ELLEN
Last Name:WINSTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 SE COURTNEY RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7104
Mailing Address - Country:US
Mailing Address - Phone:503-659-1055
Mailing Address - Fax:503-513-0426
Practice Address - Street 1:3016 SE COURTNEY RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7104
Practice Address - Country:US
Practice Address - Phone:503-659-1055
Practice Address - Fax:503-513-0426
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD85981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice