Healthcare Provider Details

I. General information

NPI: 1306965009
Provider Name (Legal Business Name): WILLIAM H. WOODWARD JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 LARGO CENTER DR
LARGO MD
20774-3704
US

IV. Provider business mailing address

932 LARGO CENTER DR
LARGO MD
20774-3704
US

V. Phone/Fax

Practice location:
  • Phone: 301-322-8900
  • Fax: 301-322-2840
Mailing address:
  • Phone: 301-322-8900
  • Fax: 301-322-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5968
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: