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General NPI Number Information
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NPI Number | 1073519146
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Entity Type | Individual
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Provider Name | JOHN DOUGLAS WOODDELL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3299 WOODBURN RD STE 440
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City | ANNANDALE
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State | VA
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Zip | 22003-7329
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Country | US
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Telephone | 703-698-9698
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Fax | 703-849-0935
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Provider Business Mailing Address
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Address Line | 3299 WOODBURN RD STE 440
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City | ANNANDALE
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State | VA
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Zip | 22003-7329
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Country | US
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Telephone | 703-698-9698
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Fax | 703-849-0935
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6607
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License Number State | VA
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