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General NPI Number Information
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NPI Number | 1134292196
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Entity Type | Organization
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Legal Business Name | KEITH WOODALL DMD PC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 121 NORTH 20TH STREET 20A
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City | OPELIKA
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State | AL
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Zip | 36801
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Country | US
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Telephone | 334-749-1268
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Fax | 334-745-4221
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Provider Business Mailing Address
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Address Line | 121 NORTH 20TH STREET 20A
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City | OPELIKA
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State | AL
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Zip | 36801
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Country | US
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Telephone | 334-749-1268
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Fax | 334-745-4221
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Authorized Official
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Title or Position | ORTHODONTIST PRESIDENT
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Name | PAUL KEITH WOODALL SR.
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Credential | DMD
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Telephone | 334-749-1268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2832
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License Number State | AL
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