Provider Demographics
NPI:1669819371
Name:WOODWARD, NATHAN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:E
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 1:16040 US HIGHWAY 160
Mailing Address - Street 2:P.O.BOX 339
Mailing Address - City:FORSYTH
Mailing Address - State:MO
Mailing Address - Zip Code:65653-8100
Mailing Address - Country:US
Mailing Address - Phone:417-546-2151
Mailing Address - Fax:417-546-6866
Practice Address - Street 1:16040 US HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:MO
Practice Address - Zip Code:65653-8100
Practice Address - Country:US
Practice Address - Phone:417-546-2151
Practice Address - Fax:417-546-6866
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013016295122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist