Provider Demographics
NPI:1184820078
Name:JOHN C. WOODALL, D.D.S., P.A.
Entity Type:Organization
Organization Name:JOHN C. WOODALL, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.A.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-821-2595
Mailing Address - Street 1:2020 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2316
Mailing Address - Country:US
Mailing Address - Phone:919-821-2595
Mailing Address - Fax:
Practice Address - Street 1:2020 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-2316
Practice Address - Country:US
Practice Address - Phone:919-821-2595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC44571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty