Provider Demographics
NPI:1093885550
Name:WOODWARD, MARK ALLAN (DMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLAN
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E HASTINGS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218
Mailing Address - Country:US
Mailing Address - Phone:509-467-0755
Mailing Address - Fax:509-467-8227
Practice Address - Street 1:510 E HASTINGS RD
Practice Address - Street 2:SUITE A
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218
Practice Address - Country:US
Practice Address - Phone:509-467-0755
Practice Address - Fax:509-467-8227
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE9064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist