Provider Demographics
NPI:1073632055
Name:WOODLAND, BYRON B (DDS)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:B
Last Name:WOODLAND
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 1:310 N 400 E
Mailing Address - Street 2:
Mailing Address - City:NEPHI
Mailing Address - State:UT
Mailing Address - Zip Code:84648-1558
Mailing Address - Country:US
Mailing Address - Phone:435-623-1916
Mailing Address - Fax:435-623-7137
Practice Address - Street 1:310 NORTH 400 EAST
Practice Address - Street 2:
Practice Address - City:NEPHI
Practice Address - State:UT
Practice Address - Zip Code:84648-1558
Practice Address - Country:US
Practice Address - Phone:435-623-1916
Practice Address - Fax:435-623-7137
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT25351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice