Provider Demographics
NPI:1679622401
Name:WOODS, GAIL MARJORIE (DDS)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:MARJORIE
Last Name:WOODS
Suffix:
Gender:F
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
Mailing Address - Street 2:SUITE 7
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-2715
Mailing Address - Country:US
Mailing Address - Phone:269-279-6210
Mailing Address - Fax:
Practice Address - Street 1:57175 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093
Practice Address - Country:US
Practice Address - Phone:269-273-8602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010119681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice