Provider Demographics
NPI:1093832800
Name:WOO, ROBERT C S (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C S
Last Name:WOO
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 1:1340 8TH ST NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4700
Mailing Address - Country:US
Mailing Address - Phone:253-833-9524
Mailing Address - Fax:253-833-8316
Practice Address - Street 1:1340 8TH ST NE
Practice Address - Street 2:SUITE 101
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4700
Practice Address - Country:US
Practice Address - Phone:253-833-9524
Practice Address - Fax:253-833-8316
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000049981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT01911Medicare UPIN