MEDICARE: DR. JONATHAN H WOODYARD DMD

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	1223G0001X	General Practice Dentistry	KY 8646	KY
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1790943454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN H WOODYARD DMD

Provider Business Mailing Address
First Line	:	4915 VILLAGE SQUARE DR
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-9073
Country	:	US
Telephone Number	:	270-408-1321
Fax Number	:

Provider Business Practice Location Address
First Line	:	4915 VILLAGE SQUARE DR
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-9073
Country	:	US
Telephone Number	:	270-408-1321
Fax Number	:

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

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	11/18/2025

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