Healthcare Provider Details

I. General information

NPI: 1649450198
Provider Name (Legal Business Name): WOODSTOCK DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WOODSTOCK DENTAL CARE 28716 HWY 5 SUITE 4
WOODSTOCK AL
35188
US

IV. Provider business mailing address

28716 HWY 5 SUITE 4
WOODSTOCK AL
35188
US

V. Phone/Fax

Practice location:
  • Phone: 205-938-3318
  • Fax:
Mailing address:
  • Phone: 205-938-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4997
License Number StateAL

VIII. Authorized Official

Name: DR. KAREN W LITTLETON
Title or Position: OWNER
Credential: D.M.D.
Phone: 205-938-3313