Provider Demographics
NPI:1659388254
Name:WOODWARD, BILLY BROOKS (DDS)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:BROOKS
Last Name:WOODWARD
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 1:1111 N. CHARLES ST.
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5403
Mailing Address - Country:US
Mailing Address - Phone:410-837-2050
Mailing Address - Fax:410-837-2071
Practice Address - Street 1:1001 CATHEDRAL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5403
Practice Address - Country:US
Practice Address - Phone:410-837-2050
Practice Address - Fax:410-837-2071
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200804100Medicaid
MD132190100Medicaid
MDK802Medicare PIN
MD132190100Medicaid