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General NPI Number Information
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NPI Number | 1669736674
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Entity Type | Individual
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Provider Name | KACIE KAY WOODIS D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2012
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Last Update Date | 06/25/2012
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Provider Practice Location Address
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Address Line | 370 3RD AVE S
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City | ISLE
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State | MN
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Zip | 56342-4573
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Country | US
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Telephone | 320-676-3232
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Fax |
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Provider Business Mailing Address
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Address Line | 10494 PIERCE ST NE
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City | BLAINE
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State | MN
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Zip | 55434-3682
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Country | US
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Telephone |
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Fax |
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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 | D13123
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License Number State | MN
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