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General NPI Number Information
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NPI Number | 1629547682
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Entity Type | Organization
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Legal Business Name | WOODS ORTHODONTICS LLC
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Dates
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Enumeration Date | 11/20/2018
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Last Update Date | 11/20/2018
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Provider Practice Location Address
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Address Line | 2500 NE TWIN KNOLLS DR STE 250
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City | BEND
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State | OR
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Zip | 97701-4786
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Country | US
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Telephone | 541-385-3104
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Fax | 541-797-6700
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Provider Business Mailing Address
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Address Line | 2500 NE TWIN KNOLLS DR STE 250
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City | BEND
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State | OR
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Zip | 97701-4786
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Country | US
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Telephone | 541-385-3104
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Fax | 541-797-6700
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Authorized Official
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Title or Position | ORTHODONTIST/OWNER/MEMBER
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Name | DR. SHANNON WOODS
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Credential | DMD, MS
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Telephone | 541-385-3104
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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 |
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License Number State |
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