Provider Demographics
NPI:1053876748
Name:WOODY DENTAL PLLC
Entity type:Organization
Organization Name:WOODY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:WOODY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-488-3399
Mailing Address - Street 1:1950 N LOGAN ST APT 411
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1175
Mailing Address - Country:US
Mailing Address - Phone:714-488-3399
Mailing Address - Fax:
Practice Address - Street 1:5989 E COLFAX AVENUE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220
Practice Address - Country:US
Practice Address - Phone:714-488-3399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty