Provider Demographics
NPI:1417176488
Name:WOODWARD, GREGG MARTIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:MARTIN
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N ALMA SCHOOL RD STE 34
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3688
Mailing Address - Country:US
Mailing Address - Phone:480-726-6697
Mailing Address - Fax:480-726-6893
Practice Address - Street 1:610 N ALMA SCHOOL RD STE 34
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3688
Practice Address - Country:US
Practice Address - Phone:480-726-6697
Practice Address - Fax:480-726-6893
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice