Provider Demographics
NPI:1568638633
Name:DRS. WOO AND DEBERARDINIS
Entity Type:Organization
Organization Name:DRS. WOO AND DEBERARDINIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-762-0211
Mailing Address - Street 1:1476 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 506
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-1500
Mailing Address - Country:US
Mailing Address - Phone:707-762-0211
Mailing Address - Fax:707-762-5149
Practice Address - Street 1:1476 PROFESSIONAL DR
Practice Address - Street 2:SUITE 506
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1500
Practice Address - Country:US
Practice Address - Phone:707-762-0211
Practice Address - Fax:707-762-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA395791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty