Provider Demographics
NPI:1346639366
Name:L. KEITH WOODY DMD, INC.
Entity Type:Organization
Organization Name:L. KEITH WOODY DMD, INC.
Other - Org Name:LLOYD K. WOODY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:L. KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-789-9092
Mailing Address - Street 1:P.O. BOX 1661
Mailing Address - Street 2:325 BROADWAY ST
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240
Mailing Address - Country:US
Mailing Address - Phone:606-789-9092
Mailing Address - Fax:606-789-4428
Practice Address - Street 1:325 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1348
Practice Address - Country:US
Practice Address - Phone:606-789-9092
Practice Address - Fax:606-789-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV381COD3224Medicaid
KY60062404Medicaid