MEDICARE: DR. JERON PHILLIP WINSLOW D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	57368	CA
2	1223G0001X	General Practice Dentistry	41092	TX

General Provider Information

NPI Number	:	1417113960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERON PHILLIP WINSLOW D.D.S.

Provider Business Mailing Address
First Line	:	2603 BRAZOS DR
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7350
Country	:	US
Telephone Number	:	916-515-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2205 HARWOOD RD
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-3607
Country	:	US
Telephone Number	:	817-354-0606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	11/24/2025

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