Provider Demographics
NPI:1275746448
Name:WOODLL, JOHN CHARLES (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:WOODLL
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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:919-821-7816
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:919-821-7816
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC44571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice