Provider Demographics
NPI:1780680728
Name:WOODFORD, SCOTT H (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:H
Last Name:WOODFORD
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:PO BOX 566
Mailing Address - Street 2:817 BOSTON POST ROAD
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-0566
Mailing Address - Country:US
Mailing Address - Phone:203-245-4266
Mailing Address - Fax:203-245-6933
Practice Address - Street 1:817 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3155
Practice Address - Country:US
Practice Address - Phone:203-245-4266
Practice Address - Fax:203-245-6933
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0065281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice