Provider Demographics
NPI:1578672085
Name:WOODRUFF, S. CLARKE (DMD)
Entity Type:Individual
Prefix:DR
First Name:S.
Middle Name:CLARKE
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MAIN ST
Mailing Address - Street 2:SUITE102
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1535
Mailing Address - Country:US
Mailing Address - Phone:610-838-6597
Mailing Address - Fax:610-838-6598
Practice Address - Street 1:800 MAIN ST
Practice Address - Street 2:SUITE102
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1535
Practice Address - Country:US
Practice Address - Phone:610-838-6597
Practice Address - Fax:610-838-6598
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS21651L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist