Healthcare Provider Details

I. General information

NPI: 1942572391
Provider Name (Legal Business Name): DOUGLAS G. WOODSON, DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 ROBERT S KERR AVE SUITE 130
OKLAHOMA CITY OK
73102-5217
US

IV. Provider business mailing address

228 ROBERT S KERR AVE SUITE 130
OKLAHOMA CITY OK
73102-5217
US

V. Phone/Fax

Practice location:
  • Phone: 405-232-8743
  • Fax: 405-232-2309
Mailing address:
  • Phone: 405-232-8743
  • Fax: 405-232-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4154
License Number StateOK

VIII. Authorized Official

Name: DR. DOUGLAS GREG WOODSON
Title or Position: OWNER
Credential: DDS
Phone: 405-232-8743