Individual
MS. AUDREY LEE WINGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1513 FREMONT BLVD # E-2, SEASIDE, CA 93955-4319
(831) 324-4492
Mailing address
6484 COOPER ST, FELTON, CA 95018-9402
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
59475
CA
Other
Enumeration date
07/28/2010
Last updated
07/28/2010
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