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General NPI Number Information
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NPI Number | 1871637355
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Entity Type | Organization
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Legal Business Name | STEPHEN M. WOODALL, DDS
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 05/05/2014
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Provider Practice Location Address
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Address Line | 3180 WILLOW LN SUITE 208
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-4941
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Country | US
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Telephone | 805-496-9775
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Fax | 805-373-7084
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Provider Business Mailing Address
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Address Line | 3180 WILLOW LN SUITE 208
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-4941
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Country | US
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Telephone | 805-496-9775
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Fax | 805-373-7084
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVE WOODALL
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Credential | DDS
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Telephone | 805-496-9775
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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 | 45794
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License Number State | CA
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