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General NPI Number Information
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NPI Number | 1790106359
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Entity Type | Organization
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Legal Business Name | MARK A WOODWARD DMD PS
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Dates
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Enumeration Date | 12/30/2013
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Last Update Date | 12/30/2013
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Provider Practice Location Address
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Address Line | 510 E HASTINGS RD SUITE A
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City | SPOKANE
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State | WA
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Zip | 99218-1900
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Country | US
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Telephone | 509-467-0755
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Fax | 509-467-8227
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Provider Business Mailing Address
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Address Line | 510 E HASTINGS RD SUITE A
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City | SPOKANE
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State | WA
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Zip | 99218-1900
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Country | US
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Telephone | 509-467-0755
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Fax | 509-467-8227
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MARK ALLAN WOODWARD
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Credential | DMD
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Telephone | 509-467-0755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE9064
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License Number State | WA
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