Provider Demographics
NPI:1003997107
Name:WOODRUFF, BRUCE ARTHUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ARTHUR
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13326
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3326
Mailing Address - Country:US
Mailing Address - Phone:850-309-0095
Mailing Address - Fax:850-309-1662
Practice Address - Street 1:2880 CAPITAL MEDICAL BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4671
Practice Address - Country:US
Practice Address - Phone:850-309-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN155201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL83006AMedicare ID - Type Unspecified