Provider Demographics
NPI:1326112319
Name:TREVINO, WINONA SHAWN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:WINONA
Middle Name:SHAWN
Last Name:TREVINO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:WINONA
Other - Middle Name:SHAWN
Other - Last Name:MOCZYGEMBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:413 W SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5349
Mailing Address - Country:US
Mailing Address - Phone:956-781-8880
Mailing Address - Fax:956-781-8977
Practice Address - Street 1:413 W SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5349
Practice Address - Country:US
Practice Address - Phone:956-781-8880
Practice Address - Fax:956-781-8977
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037347403Medicaid