Provider Demographics
NPI:1790106359
Name:MARK A WOODWARD DMD PS
Entity Type:Organization
Organization Name:MARK A WOODWARD DMD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-467-0755
Mailing Address - Street 1:510 E HASTINGS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1900
Mailing Address - Country:US
Mailing Address - Phone:509-467-0755
Mailing Address - Fax:509-467-8227
Practice Address - Street 1:510 E HASTINGS RD
Practice Address - Street 2:SUITE A
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1900
Practice Address - Country:US
Practice Address - Phone:509-467-0755
Practice Address - Fax:509-467-8227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE9064261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental