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General NPI Number Information
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NPI Number | 1104838531
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Entity Type | Organization
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Legal Business Name | GARY R. WINSLOW D.D.S., INC.
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1920 E 17TH ST SUITE 100
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City | SANTA ANA
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State | CA
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Zip | 92705-8626
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Country | US
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Telephone | 714-953-6881
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 E 17TH ST SUITE 100
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City | SANTA ANA
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State | CA
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Zip | 92705-8626
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Country | US
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Telephone | 714-953-6881
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY R WINLSOW
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Credential | DDS
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Telephone | 714-953-6881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19991
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License Number State | CA
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