Provider Demographics
NPI:1346466356
Name:SARITA L WOODSON DDS
Entity Type:Organization
Organization Name:SARITA L WOODSON DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-660-9113
Mailing Address - Street 1:715 LAKE ST
Mailing Address - Street 2:STE 240
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1411
Mailing Address - Country:US
Mailing Address - Phone:708-660-9113
Mailing Address - Fax:708-660-2207
Practice Address - Street 1:715 LAKE ST
Practice Address - Street 2:STE 240
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1411
Practice Address - Country:US
Practice Address - Phone:708-660-9113
Practice Address - Fax:708-660-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190233191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty