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General NPI Number Information
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NPI Number | 1366628182
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Entity Type | Organization
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Legal Business Name | MONICA WOODARD DDS MDS PC
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 01/10/2008
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Provider Practice Location Address
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Address Line | 5833 HARBOUR VIEW BLVD SUITE A
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City | SUFFOLK
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State | VA
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Zip | 23435-2657
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Country | US
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Telephone | 757-686-3955
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Fax |
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Provider Business Mailing Address
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Address Line | 5833 HARBOUR VIEW BLVD SUITE A
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City | SUFFOLK
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State | VA
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Zip | 23435-2657
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Country | US
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Telephone | 757-686-3955
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Fax |
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Authorized Official
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Title or Position | PRACTICE COORDINATOR
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Name | MIA TURNER
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Credential |
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Telephone | 757-686-3955
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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 | 0401411138
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License Number State | VA
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