MEDICARE: DONNA WOODRUFF

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	6737	NC

General Provider Information

NPI Number	:	1992876288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA WOODRUFF

Provider Business Mailing Address
First Line	:	1037 W STERLINGTON PL
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27502-8938
Country	:	US
Telephone Number	:	919-656-2331
Fax Number	:	919-787-9552

Provider Business Practice Location Address
First Line	:	4064 BARRETT DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-6604
Country	:	US
Telephone Number	:	919-656-2331
Fax Number	:	919-787-9556

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

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/08/2007

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