Provider Demographics
NPI:1710175484
Name:DONAL R WOODWARD DDS, INC.
Entity Type:Organization
Organization Name:DONAL R WOODWARD DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-492-6994
Mailing Address - Street 1:6143 E 91ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-3104
Mailing Address - Country:US
Mailing Address - Phone:918-492-6994
Mailing Address - Fax:918-496-8711
Practice Address - Street 1:6143 E 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-3104
Practice Address - Country:US
Practice Address - Phone:918-492-6994
Practice Address - Fax:918-496-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46381223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK447660075Medicare PIN