Provider Demographics
NPI:1629229547
Name:WOFFORD, JIMMY A (DDS)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:A
Last Name:WOFFORD
Suffix:
Gender:M
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 1016
Mailing Address - Street 2:
Mailing Address - City:FT. STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735
Mailing Address - Country:US
Mailing Address - Phone:432-336-5522
Mailing Address - Fax:432-336-5523
Practice Address - Street 1:413 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:FT. STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735
Practice Address - Country:US
Practice Address - Phone:432-336-5522
Practice Address - Fax:432-336-5523
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10759122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist