Provider Demographics
NPI:1750639753
Name:WOODHULL, BRIAN MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:WOODHULL
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 1:10650 GARDEN DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-7018
Mailing Address - Country:US
Mailing Address - Phone:303-366-5100
Mailing Address - Fax:303-731-0832
Practice Address - Street 1:10650 GARDEN DR
Practice Address - Street 2:SUITE 106
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-7018
Practice Address - Country:US
Practice Address - Phone:303-366-5100
Practice Address - Fax:303-731-0832
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO107721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice