=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639660251
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL W. WOODS DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2018
-----------------------------------------------------
Last Update Date | 11/08/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5730 WARD RD STE 203
-----------------------------------------------------
City | ARVADA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80002-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-423-0930
-----------------------------------------------------
Fax | 303-423-1034
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5730 WARD RD STE 203
-----------------------------------------------------
City | ARVADA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80002-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-423-0930
-----------------------------------------------------
Fax | 303-423-1034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING AGENT
-----------------------------------------------------
Name | DOROTHY HERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 623-258-4520
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------