Healthcare Provider Details

I. General information

NPI: 1174522965
Provider Name (Legal Business Name): JOSEPH ANDERSON WOODARD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W 8TH ST
COLUMBIA TN
38401-3101
US

IV. Provider business mailing address

311 W 8TH ST
COLUMBIA TN
38401-3101
US

V. Phone/Fax

Practice location:
  • Phone: 931-388-1935
  • Fax: 931-388-2336
Mailing address:
  • Phone: 931-388-1935
  • Fax: 931-388-2336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS-2747
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: