Provider Demographics
NPI:1467462408
Name:WOODDELL, TERESA L (DDS,PA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:WOODDELL
Suffix:
Gender:F
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 CARTHAGE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4161
Mailing Address - Country:US
Mailing Address - Phone:919-774-1733
Mailing Address - Fax:919-775-2537
Practice Address - Street 1:1144 CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4161
Practice Address - Country:US
Practice Address - Phone:919-774-1733
Practice Address - Fax:919-775-2537
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice