Provider Demographics
NPI:1205835956
Name:WOODRUFF, THOMAS FRANKLIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FRANKLIN
Last Name:WOODRUFF
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:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-4111
Mailing Address - Fax:520-818-3630
Practice Address - Street 1:3690 S PARK AVE STE 805
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-5042
Practice Address - Country:US
Practice Address - Phone:520-616-6760
Practice Address - Fax:520-616-6799
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0098581223G0001X
OH30016510122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ335318Medicaid