Provider Demographics
NPI:1568618213
Name:WOODWARD, JUSTIN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:J
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9829 S 1300 E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-4000
Mailing Address - Country:US
Mailing Address - Phone:801-553-3562
Mailing Address - Fax:801-553-3564
Practice Address - Street 1:9829 S 1300 E
Practice Address - Street 2:SUITE 102
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-4000
Practice Address - Country:US
Practice Address - Phone:801-553-3562
Practice Address - Fax:801-553-3564
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT47420579922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist