Provider Demographics
NPI:1306373568
Name:WINN DENTAL PRACTICE, INC.
Entity Type:Organization
Organization Name:WINN DENTAL PRACTICE, INC.
Other - Org Name:CENTRAL COAST DENTAL ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:WINN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-636-3956
Mailing Address - Street 1:1531 HOLIDAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-1836
Mailing Address - Country:US
Mailing Address - Phone:805-636-3956
Mailing Address - Fax:888-232-8536
Practice Address - Street 1:1333 DE LA VINA ST STE H
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-5159
Practice Address - Country:US
Practice Address - Phone:805-636-3956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62214261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental