MEDICARE: HERBERT S WOODWARD III DDS INC

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	122300000X	Dentist	30724	CA

General Provider Information

NPI Number	:	1417921966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERBERT S WOODWARD III DDS INC

Provider Business Mailing Address
First Line	:	325 CARLSBAD VILLAGE DR
Second Line	:	SUITE A-2
City	:	CARLSBAD
State	:	CA
Zip	:	92008-2928
Country	:	US
Telephone Number	:	760-729-2901
Fax Number	:	760-729-2542

Provider Business Practice Location Address
First Line	:	325 CARLSBAD VILLAGE DR
Second Line	:	SUITE A-2
City	:	CARLSBAD
State	:	CA
Zip	:	92008-2928
Country	:	US
Telephone Number	:	760-729-2901
Fax Number	:	760-729-2542

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HERBERT STARR WOODWARD III
Credential	:	DDS
Telephone Number	:	760-729-2901

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	04/14/2016

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