Provider Demographics
NPI:1245308337
Name:WINTON, JASINA CAMILLE (DDS)
Entity type:Individual
Prefix:DR
First Name:JASINA
Middle Name:CAMILLE
Last Name:WINTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2591 LYNNFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-7934
Mailing Address - Country:US
Mailing Address - Phone:901-515-5257
Mailing Address - Fax:901-544-7602
Practice Address - Street 1:1000 HAYNES ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38114-3374
Practice Address - Country:US
Practice Address - Phone:901-515-5257
Practice Address - Fax:901-544-7602
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN82661223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440307Medicaid
TN9179667OtherDORAL DENTAL PROVIDER #
TN8266OtherLICENSE