MEDICARE: DR. WOODS RAYBURN WOOLWINE III D.D.S.

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	8024940-9922	UT
2	1223G0001X	General Practice Dentistry	30553	TX

General Provider Information

NPI Number	:	1982991261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WOODS RAYBURN WOOLWINE III D.D.S.

Provider Business Mailing Address
First Line	:	155 E SONTERRA BLVD STE 205
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3989
Country	:	US
Telephone Number	:	210-341-3222
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 E SONTERRA BLVD STE 205
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3989
Country	:	US
Telephone Number	:	210-341-3222
Fax Number	:	210-341-8607

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

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	03/26/2020

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