Healthcare Provider Details

I. General information

NPI: 1003220260
Provider Name (Legal Business Name): MICHAEL WOODBECK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 S BROADWAY STE B
ENGLEWOOD CO
80113-9304
US

IV. Provider business mailing address

5120 S BROADWAY STE B
ENGLEWOOD CO
80113-9304
US

V. Phone/Fax

Practice location:
  • Phone: 720-792-5095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number203932
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: