Provider Demographics
NPI:1639660251
Name:MICHAEL W. WOODS DDS PC
Entity Type:Organization
Organization Name:MICHAEL W. WOODS DDS PC
Other - Org Name:MICHAEL W WOODS DDS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-258-4520
Mailing Address - Street 1:5730 WARD RD STE 203
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1300
Mailing Address - Country:US
Mailing Address - Phone:303-423-0930
Mailing Address - Fax:303-423-1034
Practice Address - Street 1:5730 WARD RD STE 203
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1300
Practice Address - Country:US
Practice Address - Phone:303-423-0930
Practice Address - Fax:303-423-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27342403OtherLICENSE