Provider Demographics
NPI:1629547682
Name:WOODS ORTHODONTICS LLC
Entity Type:Organization
Organization Name:WOODS ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:541-385-3104
Mailing Address - Street 1:2500 NE TWIN KNOLLS DR STE 250
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4786
Mailing Address - Country:US
Mailing Address - Phone:541-385-3104
Mailing Address - Fax:541-797-6700
Practice Address - Street 1:2500 NE TWIN KNOLLS DR STE 250
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4786
Practice Address - Country:US
Practice Address - Phone:541-385-3104
Practice Address - Fax:541-797-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty