Provider Demographics
NPI:1073519146
Name:WOODDELL, JOHN DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:WOODDELL
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 1:3299 WOODBURN RD
Mailing Address - Street 2:STE 440
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-7329
Mailing Address - Country:US
Mailing Address - Phone:703-698-9698
Mailing Address - Fax:703-849-0935
Practice Address - Street 1:3299 WOODBURN RD
Practice Address - Street 2:STE 440
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-7329
Practice Address - Country:US
Practice Address - Phone:703-698-9698
Practice Address - Fax:703-849-0935
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA66071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA502107OtherUNITED CONCORDIA
VA078334OtherBLUE CROSS/TRIGON