Provider Demographics
NPI:1962526707
Name:WINSTON, MOLLIE ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:MOLLIE
Middle Name:ANN
Last Name:WINSTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MOLLIE
Other - Middle Name:ANN
Other - Last Name:WINSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:10930 CRABAPPLE RD STE 160
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7631
Mailing Address - Country:US
Mailing Address - Phone:770-934-1907
Mailing Address - Fax:770-493-4900
Practice Address - Street 1:10930 CRABAPPLE RD STE 160
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7631
Practice Address - Country:US
Practice Address - Phone:770-934-1907
Practice Address - Fax:770-493-4900
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery