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General NPI Number Information
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NPI Number | 1194813352
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Entity Type | Individual
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Provider Name | STEVEN NILES WOODALL D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 11/11/2009
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Provider Practice Location Address
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Address Line | 237 S CARROLL RD
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City | VILLA RICA
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State | GA
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Zip | 30180-2607
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Country | US
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Telephone | 770-459-1956
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1927
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City | VILLA RICA
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State | GA
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Zip | 30180-6439
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Country | US
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Telephone | 770-459-1956
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN012989
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License Number State | GA
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