1679123012 NPI number — SWEET TOOTH PEDIATRIC DENTISTRY CORP

Table of content: DAVID EVERETT WINSLOW D.O. (NPI 1366524266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679123012 NPI number — SWEET TOOTH PEDIATRIC DENTISTRY CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWEET TOOTH PEDIATRIC DENTISTRY CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679123012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1040 WESTON RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33326-1912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-384-8888
Provider Business Mailing Address Fax Number:
954-384-9434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 WESTON RD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33326-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-384-8888
Provider Business Practice Location Address Fax Number:
954-384-9434
Provider Enumeration Date:
09/18/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ARROYO
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER/ DENTIST
Authorized Official Telephone Number:
925-216-5652

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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