Provider Demographics
NPI:1851455471
Name:JO ELLEN WINSTON, DMD
Entity Type:Organization
Organization Name:JO ELLEN WINSTON, DMD
Other - Org Name:WINSTON FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:WALDECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-659-1055
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:503-702-5951
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:503-702-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD85981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty