Healthcare Provider Details

I. General information

NPI: 1639244940
Provider Name (Legal Business Name): SCOTT C WOODBURY DMD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 FASHION SQUARE BOULEVARD
SAGINAW MI
48603-1249
US

IV. Provider business mailing address

4350 FASHION SQUARE BOULEVARD
SAGINAW MI
48603-1249
US

V. Phone/Fax

Practice location:
  • Phone: 989-799-7128
  • Fax: 989-799-3895
Mailing address:
  • Phone: 989-799-7128
  • Fax: 989-799-3895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901017356
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number2901017356
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: