Provider Demographics
NPI:1578850350
Name:WINSLOW DENTAL CORPORATION
Entity Type:Organization
Organization Name:WINSLOW DENTAL CORPORATION
Other - Org Name:NEW ESSENCE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERON
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:WINSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-515-1000
Mailing Address - Street 1:4000 TRUXEL RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-3726
Mailing Address - Country:US
Mailing Address - Phone:916-515-1000
Mailing Address - Fax:916-515-1110
Practice Address - Street 1:4000 TRUXEL RD STE 2
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3726
Practice Address - Country:US
Practice Address - Phone:916-515-1000
Practice Address - Fax:916-515-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA573681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty