MEDICARE: DONAL R WOODWARD DDS, INC.

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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	4638	OK

General Provider Information

NPI Number	:	1710175484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONAL R WOODWARD DDS, INC.

Provider Business Mailing Address
First Line	:	6143 E 91ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-3104
Country	:	US
Telephone Number	:	918-492-6994
Fax Number	:	918-496-8711

Provider Business Practice Location Address
First Line	:	6143 E 91ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-3104
Country	:	US
Telephone Number	:	918-492-6994
Fax Number	:	918-496-8711

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONAL R WOODWARD
Credential	:	DDS
Telephone Number	:	918-492-6994

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	07/30/2008

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