NPIMap

Organization Active NPI

Soe L. Wynn, DMD, Inc.

  • Dentist
  • Modesto, CA
National Provider Identifier
1689795718
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
45058 Issued in CA
Legal business name
SOE L. WYNN, DMD, INC.
Doing business as
Allstar Family Dentistry
Practice address
2030 Coffee Rd
Suite C-4
Modesto, CA 95355-2413
Phone
(209) 238-9444
Fax
(209) 238-9446
NPI assigned
Apr 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Soe Lwin Wynn, DMDNPI 1750362976
Title
President
Phone
(209) 238-9444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 45058 CA Primary

Addresses

Primary practice location

2030 Coffee Rd
Suite C-4
Modesto, CA 95355-2413

Mailing address

2030 Coffee Road
Suite C-4
Modesto, CA 95355-8425
Phone (209) 238-9444

Other names 1

  • Allstar Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

2030 Coffee Rd
Ste C4
Modesto, CA 95355
Phone (209) 238-9444

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1689795718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2030 COFFEE ROAD",
            "address_2": "SUITE C-4",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953558425",
            "telephone_number": "209-238-9444",
            "fax_number": "209-238-9446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 COFFEE RD",
            "address_2": "SUITE C-4",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552413",
            "telephone_number": "209-238-9444",
            "fax_number": "209-238-9446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOE L. WYNN, DMD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "WYNN",
        "authorized_official_first_name": "SOE",
        "authorized_official_middle_name": "LWIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-238-9444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "45058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allstar Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.