Provider Demographics
NPI:1053462127
Name:WOODYARD, JAMES G (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:WOODYARD
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4886 ROSEBUD LANE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630
Mailing Address - Country:US
Mailing Address - Phone:812-473-4833
Mailing Address - Fax:
Practice Address - Street 1:4886 ROSEBUD LANE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630
Practice Address - Country:US
Practice Address - Phone:812-473-4833
Practice Address - Fax:812-473-4842
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010599A1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
INBW6386153OtherDEA
INBW6386153OtherDEA