Provider Demographics
NPI:1386287027
Name:WINSLOW DDS INC.
Entity type:Organization
Organization Name:WINSLOW DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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 1:10043 BRUCEVILLE ROAD
Practice Address - Street 2:UNIT 160
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757
Practice Address - Country:US
Practice Address - Phone:916-515-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental