Provider Demographics
NPI:1568777654
Name:WOODS, LARESEA (DDS)
Entity Type:Individual
Prefix:
First Name:LARESEA
Middle Name:
Last Name:WOODS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 MONTE RANCH TRL
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-4371
Mailing Address - Country:US
Mailing Address - Phone:334-590-4223
Mailing Address - Fax:870-642-7655
Practice Address - Street 1:1620 GRAND AVENUE PKWY STE 130
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2185
Practice Address - Country:US
Practice Address - Phone:512-670-8482
Practice Address - Fax:512-215-8154
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3787122300000X
TX332591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist