Provider Demographics
NPI:1710093117
Name:WOODSON, JAMES DAVID (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:WOODSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 POWDERSVILLE MAIN
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-9354
Mailing Address - Country:US
Mailing Address - Phone:864-269-2139
Mailing Address - Fax:
Practice Address - Street 1:200 PRISON RD
Practice Address - Street 2:
Practice Address - City:ENOREE
Practice Address - State:SC
Practice Address - Zip Code:29335-9309
Practice Address - Country:US
Practice Address - Phone:803-896-3526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC01977122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist