Provider Demographics
NPI:1134292196
Name:KEITH WOODALL DMD PC
Entity Type:Organization
Organization Name:KEITH WOODALL DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WOODALL
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-749-1268
Mailing Address - Street 1:121 NORTH 20TH STREET
Mailing Address - Street 2:20A
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801
Mailing Address - Country:US
Mailing Address - Phone:334-749-1268
Mailing Address - Fax:334-745-4221
Practice Address - Street 1:121 NORTH 20TH STREET
Practice Address - Street 2:20A
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801
Practice Address - Country:US
Practice Address - Phone:334-749-1268
Practice Address - Fax:334-745-4221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty