MEDICARE: DR. MCKENNA JO WOODWARD DDS

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	DDS-09995	IA
2	1223D0001X	Public Health Dentistry	DDS-09995	IA

General Provider Information

NPI Number	:	1245960012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MCKENNA JO WOODWARD DDS

Provider Business Mailing Address
First Line	:	1210 4TH AVE SE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-4085
Country	:	US
Telephone Number	:	319-730-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 4TH AVE SE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-4085
Country	:	US
Telephone Number	:	319-730-7300
Fax Number	:

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

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	04/09/2024

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