Provider Demographics
NPI:1639390826
Name:DR. THOMAS WOODARD P.A.
Entity Type:Organization
Organization Name:DR. THOMAS WOODARD P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-548-1653
Mailing Address - Street 1:8220 UNIVERSITY EXEC PARK DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3380
Mailing Address - Country:US
Mailing Address - Phone:704-548-1653
Mailing Address - Fax:704-548-8761
Practice Address - Street 1:8220 UNIVERSITY EXEC PARK DR
Practice Address - Street 2:SUITE 150
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3380
Practice Address - Country:US
Practice Address - Phone:704-548-1653
Practice Address - Fax:704-548-8761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC44211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty