Provider Demographics
NPI:1659592897
Name:THOMAS WOODARD DDS P C
Entity Type:Organization
Organization Name:THOMAS WOODARD DDS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
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:757-455-5040
Mailing Address - Street 1:415 N MILITARY HWY STE 8
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-5407
Mailing Address - Country:US
Mailing Address - Phone:757-455-5040
Mailing Address - Fax:757-455-5043
Practice Address - Street 1:415 N MILITARY HWY STE 8
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-5407
Practice Address - Country:US
Practice Address - Phone:757-455-5040
Practice Address - Fax:757-455-5043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4010080791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9180412Medicaid