Healthcare Provider Details

I. General information

NPI: 1518955194
Provider Name (Legal Business Name): JOSEPH MARTIN WOODHOUSE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: JOE WOODHOUSE D.D.S.

II. Dates (important events)

Enumeration Date: 10/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 YOUNG AVE
MUSCATINE IA
52761-3435
US

IV. Provider business mailing address

1616 YOUNG AVE
MUSCATINE IA
52761-3435
US

V. Phone/Fax

Practice location:
  • Phone: 563-263-4106
  • Fax: 563-263-0831
Mailing address:
  • Phone: 563-263-4106
  • Fax: 563-263-0831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6273
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: