Provider Demographics
NPI:1053462911
Name:WOODBURY, RAYMOND LAMONT (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:LAMONT
Last Name:WOODBURY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30900 FORD RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-1892
Mailing Address - Country:US
Mailing Address - Phone:734-522-7119
Mailing Address - Fax:734-522-7142
Practice Address - Street 1:30900 FORD RD
Practice Address - Street 2:SUITE G
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1892
Practice Address - Country:US
Practice Address - Phone:734-522-7119
Practice Address - Fax:734-522-7142
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0170551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice