Provider Demographics
NPI:1467819680
Name:JUDITH WOODRUFF DDS PLLC
Entity Type:Organization
Organization Name:JUDITH WOODRUFF DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-529-6060
Mailing Address - Street 1:1319 HAL GREER BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3803
Mailing Address - Country:US
Mailing Address - Phone:304-529-6060
Mailing Address - Fax:304-529-6062
Practice Address - Street 1:1319 HAL GREER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3803
Practice Address - Country:US
Practice Address - Phone:304-529-6060
Practice Address - Fax:304-529-6062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2401122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1922104769Medicaid