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General NPI Number Information
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NPI Number | 1366435331
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Entity Type | Individual
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Provider Name | JON MICHAEL WOODRUFF DDS
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Gender | Male
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Dates
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Enumeration Date | 08/25/2005
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 861 E ALLEGHENY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19134-2401
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Country | US
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Telephone | 215-302-3156
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Fax | 215-329-2369
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Provider Business Mailing Address
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Address Line | 861 E ALLEGHENY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19134-2401
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Country | US
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Telephone | 215-302-3156
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Fax | 215-329-2369
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 6814
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS044372
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS044372
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License Number State | PA
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