Provider Demographics
NPI:1366628182
Name:MONICA WOODARD DDS MDS PC
Entity Type:Organization
Organization Name:MONICA WOODARD DDS MDS PC
Other - Org Name:WOODARD ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-686-3955
Mailing Address - Street 1:5833 HARBOUR VIEW BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2657
Mailing Address - Country:US
Mailing Address - Phone:757-686-3955
Mailing Address - Fax:
Practice Address - Street 1:5833 HARBOUR VIEW BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2657
Practice Address - Country:US
Practice Address - Phone:757-686-3955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014111381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9180412Medicaid