Provider Demographics
NPI:1578948469
Name:WOOLDRIDGE, DEAN (RDH)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:WOOLDRIDGE
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 N CAMINO ALTO APT 231
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2569
Mailing Address - Country:US
Mailing Address - Phone:415-505-4994
Mailing Address - Fax:
Practice Address - Street 1:1455 N CAMINO ALTO APT 231
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2569
Practice Address - Country:US
Practice Address - Phone:415-505-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20716124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist