Provider Demographics
NPI:1619601754
Name:WOODSIDE, AARON (DMD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:
Last Name:WOODSIDE
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 1:424 S HALSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-7481
Mailing Address - Country:US
Mailing Address - Phone:580-716-9011
Mailing Address - Fax:
Practice Address - Street 1:13371-14 EASTLAKE BLVD,
Practice Address - Street 2:STE 207,
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928-7992
Practice Address - Country:US
Practice Address - Phone:915-213-5480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist