Provider Demographics
NPI:1275613143
Name:WOODS, LARITA G (DMD)
Entity Type:Individual
Prefix:DR
First Name:LARITA
Middle Name:G
Last Name:WOODS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 PARKSIDE AVE
Mailing Address - Street 2:1-G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1274
Mailing Address - Country:US
Mailing Address - Phone:718-287-3700
Mailing Address - Fax:718-287-9381
Practice Address - Street 1:160 PARKSIDE AVE
Practice Address - Street 2:1-G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-1274
Practice Address - Country:US
Practice Address - Phone:718-287-3700
Practice Address - Fax:718-287-9381
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039816122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist