Provider Demographics
NPI:1699812958
Name:WOODWARD, JOHN BARCLAY III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BARCLAY
Last Name:WOODWARD
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3211 WILDWOOD PLANTATION DRIVE
Mailing Address - Street 2:ADVANCED DENTAL CARE
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605
Mailing Address - Country:US
Mailing Address - Phone:229-242-4441
Mailing Address - Fax:229-242-4471
Practice Address - Street 1:3211 WILDWOOD PLANTATION DRIVE
Practice Address - Street 2:ADVANCED DENTAL CARE
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605
Practice Address - Country:US
Practice Address - Phone:229-242-4441
Practice Address - Fax:229-242-4471
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0118931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice