| Doctor Name: | KISMET WINSLOW |
| NPI Number: | 1407243736 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 606142 |
| Business Practice Address: | 553 Chetco Ln Brookings, OR - 974158159 |
| Business Phone Number: | 5414696621 |
| Business Fax Number: | 5414128248 |
| Mailing Address: | Po Box 5540, BROOKINGS |
| State: | OR |
| Postal Code: | 974150108 |
| Phone Number: | 5414696621 |
| Fax Number: | 5414128248 |
| NPI Enumeration Date: | 04/24/2015 |
| NPI Last Update Date: | 04/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | 606142 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |