Provider Demographics
NPI:1578825170
Name:WOODY, SHAUNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:
Last Name:WOODY
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 1:1106 2ND ST
Mailing Address - Street 2:SUITE #198
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5008
Mailing Address - Country:US
Mailing Address - Phone:415-939-5710
Mailing Address - Fax:
Practice Address - Street 1:9840 HIBERT ST
Practice Address - Street 2:SUITE B-4
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1071
Practice Address - Country:US
Practice Address - Phone:858-693-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA631331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry