Provider Demographics
NPI:1629142039
Name:WOODY, L. KEITH (DMD)
Entity Type:Individual
Prefix:MR
First Name:L. KEITH
Middle Name:
Last Name:WOODY
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:PO BOX 1661
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-5661
Mailing Address - Country:US
Mailing Address - Phone:606-789-9092
Mailing Address - Fax:606-789-4428
Practice Address - Street 1:325 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1348
Practice Address - Country:US
Practice Address - Phone:606-789-9092
Practice Address - Fax:606-789-4428
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV381COD3224OtherMEDICAID
KY60062403Medicaid