MEDICARE: DONAL R WOODWARD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	4638	OK

General Provider Information

NPI Number	:	1043349855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONAL R WOODWARD DDS

Provider Business Mailing Address
First Line	:	6143 E 91ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-3104
Country	:	US
Telephone Number	:	918-492-6994
Fax Number	:

Provider Business Practice Location Address
First Line	:	6143 E 91ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-3104
Country	:	US
Telephone Number	:	918-492-6994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/29/2008

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