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General NPI Number Information
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NPI Number | 1538884861
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Entity Type | Organization
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Legal Business Name | WOODLING ORAL SURGERY PLLC
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Dates
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Enumeration Date | 10/10/2022
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 4220 VALLEY RIDGE BLVD STE 102
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City | PONTE VEDRA
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State | FL
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Zip | 32081-5172
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Country | US
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Telephone | 502-648-9915
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Fax |
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Provider Business Mailing Address
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Address Line | 1422 LAKEWOOD RD
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5322
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Country | US
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Telephone | 502-648-9915
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | TYLER WOODLING
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Credential |
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Telephone | 502-648-9915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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