Provider Demographics
NPI:1053531863
Name:WOODS, ROBERT DALE (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DALE
Last Name:WOODS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 THOMAS ST APT 7
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-2716
Mailing Address - Country:US
Mailing Address - Phone:269-279-6210
Mailing Address - Fax:
Practice Address - Street 1:57175 N MAIN ST
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-9615
Practice Address - Country:US
Practice Address - Phone:269-273-8602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010119611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382364816Medicare UPIN