Provider Demographics
NPI:1326217001
Name:RYAN C WOODMAN DMD AND VICTORIA L MALZ DMD PLLC
Entity Type:Organization
Organization Name:RYAN C WOODMAN DMD AND VICTORIA L MALZ DMD PLLC
Other - Org Name:MCKEE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-708-4402
Mailing Address - Street 1:3320 SISKEY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-3223
Mailing Address - Country:US
Mailing Address - Phone:704-708-4402
Mailing Address - Fax:
Practice Address - Street 1:3320 SISKEY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-3223
Practice Address - Country:US
Practice Address - Phone:704-708-4402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty