Provider Demographics
NPI:1073648887
Name:WOODSON, ALAN BAYLOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BAYLOR
Last Name:WOODSON
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 1:7048 ISLE CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-1691
Mailing Address - Country:US
Mailing Address - Phone:909-463-1552
Mailing Address - Fax:909-931-1284
Practice Address - Street 1:304 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5115
Practice Address - Country:US
Practice Address - Phone:909-931-1281
Practice Address - Fax:909-931-1284
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA353591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice