Provider Demographics
NPI:1639385321
Name:WOODIE, GLORIA DENT
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:DENT
Last Name:WOODIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 FLINT RIVER DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28644-8416
Mailing Address - Country:US
Mailing Address - Phone:336-982-6266
Mailing Address - Fax:
Practice Address - Street 1:870 STATE FARM RD
Practice Address - Street 2:SUITE 103-A
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4861
Practice Address - Country:US
Practice Address - Phone:828-264-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4018124Q00000X
NC7954124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist