Provider Demographics
NPI:1033209168
Name:WOODARD, ANDRA CROSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDRA
Middle Name:CROSS
Last Name:WOODARD
Suffix:
Gender:F
Credentials:DDS
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 8747
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77249-8747
Mailing Address - Country:US
Mailing Address - Phone:713-692-9486
Mailing Address - Fax:
Practice Address - Street 1:3550 W DALLAS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-1702
Practice Address - Country:US
Practice Address - Phone:713-525-8846
Practice Address - Fax:713-525-8463
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1206948-05Medicaid