MEDICARE: DR. ROBERT WILLIAM WOODWORTH D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN10205	FL

General Provider Information

NPI Number	:	1104975994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT WILLIAM WOODWORTH D.D.S.

Provider Business Mailing Address
First Line	:	511 76TH AVE
Second Line	:
City	:	ST PETE BEACH
State	:	FL
Zip	:	33706-1805
Country	:	US
Telephone Number	:	727-367-1551
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 76TH AVE
Second Line	:
City	:	ST PETE BEACH
State	:	FL
Zip	:	33706-1805
Country	:	US
Telephone Number	:	727-367-1551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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