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General NPI Number Information
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NPI Number | 1417113960
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Entity Type | Individual
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Provider Name | JERON PHILLIP WINSLOW D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 2205 HARWOOD RD
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City | BEDFORD
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State | TX
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Zip | 76021-3607
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Country | US
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Telephone | 817-354-0606
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Fax |
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Provider Business Mailing Address
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Address Line | 2603 BRAZOS DR
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City | MANSFIELD
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State | TX
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Zip | 76063-7350
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Country | US
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Telephone | 916-515-1000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 57368
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 41092
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License Number State | TX
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