MEDICARE: MR. LON E WOODRUFF 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	122300000X	Dentist	2258	AZ

General Provider Information

NPI Number	:	1265427926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LON E WOODRUFF DDS

Provider Business Mailing Address
First Line	:	5555 N 7TH STREET
Second Line	:	SUITE 142
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2531
Country	:	US
Telephone Number	:	602-265-8566
Fax Number	:	602-265-8566

Provider Business Practice Location Address
First Line	:	5555 N 7TH STREET
Second Line	:	SUITE 142
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2531
Country	:	US
Telephone Number	:	602-265-8566
Fax Number	:	602-265-8566

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	07/08/2007

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