Healthcare Provider Details

I. General information

NPI: 1245960012
Provider Name (Legal Business Name): MCKENNA JO WOODWARD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MCKENNA JO KILBURG

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 4TH AVE SE
CEDAR RAPIDS IA
52403-4085
US

IV. Provider business mailing address

1210 4TH AVE SE
CEDAR RAPIDS IA
52403-4085
US

V. Phone/Fax

Practice location:
  • Phone: 319-730-7300
  • Fax:
Mailing address:
  • Phone: 319-730-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS-09995
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDDS-09995
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: