Provider Demographics
NPI:1366447393
Name:WOODBURN, DAVID C (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:WOODBURN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 S GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-4847
Mailing Address - Country:US
Mailing Address - Phone:806-358-7471
Mailing Address - Fax:806-358-1883
Practice Address - Street 1:3609 S GEORGIA ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-4847
Practice Address - Country:US
Practice Address - Phone:806-358-7471
Practice Address - Fax:806-358-1883
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice