Provider Demographics
NPI:1558553990
Name:DANIEL K. WOODSON, DDS
Entity Type:Organization
Organization Name:DANIEL K. WOODSON, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-367-2250
Mailing Address - Street 1:PO BOX 1098
Mailing Address - Street 2:
Mailing Address - City:FORESTHILL
Mailing Address - State:CA
Mailing Address - Zip Code:95631-1098
Mailing Address - Country:US
Mailing Address - Phone:530-367-2250
Mailing Address - Fax:530-367-4735
Practice Address - Street 1:24400 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORESTHILL
Practice Address - State:CA
Practice Address - Zip Code:95631
Practice Address - Country:US
Practice Address - Phone:530-367-2250
Practice Address - Fax:530-367-4735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD23417-01Medicaid