Provider Demographics
NPI:1629165261
Name:WOODS, KENNETH C (DMD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:WOODS
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 1:212 W VINE STREET
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142
Mailing Address - Country:US
Mailing Address - Phone:724-946-3534
Mailing Address - Fax:724-946-2144
Practice Address - Street 1:212 W VINE STREET
Practice Address - Street 2:
Practice Address - City:NEW WILMINGTON
Practice Address - State:PA
Practice Address - Zip Code:16142
Practice Address - Country:US
Practice Address - Phone:724-946-3534
Practice Address - Fax:724-946-2144
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026268L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist