Provider Demographics
NPI:1679809958
Name:WOODWARD, MATHEW K (DDS)
Entity type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:K
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5397 TWIN KNOLLS RD STE 18
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3256
Mailing Address - Country:US
Mailing Address - Phone:410-730-6001
Mailing Address - Fax:410-992-4452
Practice Address - Street 1:5397 TWIN KNOLLS RD STE 18
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3256
Practice Address - Country:US
Practice Address - Phone:410-730-6001
Practice Address - Fax:410-992-4452
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014159021223S0112X
DCDEN10018471223S0112X
MD162751223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery