Healthcare Provider Details

I. General information

NPI: 1255354544
Provider Name (Legal Business Name): DAVID R WOODARD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 E 68TH ST SUITE 202
TULSA OK
74136-3323
US

IV. Provider business mailing address

5010 E 68TH ST SUITE 202
TULSA OK
74136-3323
US

V. Phone/Fax

Practice location:
  • Phone: 918-493-3500
  • Fax: 918-249-3350
Mailing address:
  • Phone: 918-493-3500
  • Fax: 918-493-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5849
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: