Healthcare Provider Details

I. General information

NPI: 1710175484
Provider Name (Legal Business Name): DONAL R WOODWARD DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6143 E 91ST ST
TULSA OK
74137-3104
US

IV. Provider business mailing address

6143 E 91ST ST
TULSA OK
74137-3104
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-6994
  • Fax: 918-496-8711
Mailing address:
  • Phone: 918-492-6994
  • Fax: 918-496-8711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number4638
License Number StateOK

VIII. Authorized Official

Name: DONAL R WOODWARD
Title or Position: PRESIDENT
Credential: DDS
Phone: 918-492-6994