Provider Demographics
NPI:1235754839
Name:WOMACK, ANNA R (DDS)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:R
Last Name:WOMACK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 LOGAN SEWELL DR
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-3342
Mailing Address - Country:US
Mailing Address - Phone:318-336-5711
Mailing Address - Fax:
Practice Address - Street 1:1148 LOGAN SEWELL DR
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-3342
Practice Address - Country:US
Practice Address - Phone:318-336-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7090122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist