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General NPI Number Information
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NPI Number | 1346639366
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Entity Type | Organization
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Legal Business Name | L. KEITH WOODY DMD, INC.
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 325 BROADWAY ST
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City | PAINTSVILLE
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State | KY
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Zip | 41240-1348
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Country | US
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Telephone | 606-789-9092
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Fax | 606-789-4428
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Provider Business Mailing Address
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Address Line | P.O. BOX 1661 325 BROADWAY ST
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City | PAINTSVILLE
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State | KY
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Zip | 41240
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Country | US
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Telephone | 606-789-9092
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Fax | 606-789-4428
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Authorized Official
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Title or Position | OWNER
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Name | L. KEITH WOODY
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Credential | DMD
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Telephone | 606-789-9092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6240
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License Number State | KY
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