Provider Demographics
NPI:1609918895
Name:WOODRUFF, VALERIE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:R
Last Name:WOODRUFF
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:PO BOX 709
Mailing Address - Street 2:200 N EASTWOOD DRIVE
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-0709
Mailing Address - Country:US
Mailing Address - Phone:217-586-5667
Mailing Address - Fax:217-586-5781
Practice Address - Street 1:200 N EASTWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-0709
Practice Address - Country:US
Practice Address - Phone:217-586-5667
Practice Address - Fax:217-586-5781
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020870122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist