Provider Demographics
NPI:1164550034
Name:WOODS, MARCUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:
Last Name:WOODS
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 1:125 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2717
Mailing Address - Country:US
Mailing Address - Phone:502-721-7566
Mailing Address - Fax:
Practice Address - Street 1:4801 OUTER LOOP
Practice Address - Street 2:SUITE A206
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3201
Practice Address - Country:US
Practice Address - Phone:502-961-0351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY79831223X0400X
IN12011076A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics