Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 038454 | NY |
NPI | 1063591881 |
---|---|
Provider Name | Dr. Brian Edward Winslow |
First Address | Webster, NY 14580-2130 |
Second Address | Webster, NY 14580-2130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 08/07/2007 |