Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 8266 | TN |
NPI | 1245308337 |
---|---|
Provider Name | Dr. Jasina Camille Winton |
First Address | Memphis, TN 38119-7934 |
Second Address | Memphis, TN 38114-3374 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5440307 | (05) | TN |
8266 | LICENSE (01) | TN |
9179667 | DORAL DENTAL PROVIDER # (01) | TN |