Provider Demographics
NPI:1811194152
Name:DONNA J. WOO, D.D.S. INC.
Entity Type:Organization
Organization Name:DONNA J. WOO, D.D.S. INC.
Other - Org Name:WESTPORT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-772-0770
Mailing Address - Street 1:420 S STATE COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-4119
Mailing Address - Country:US
Mailing Address - Phone:714-772-0770
Mailing Address - Fax:
Practice Address - Street 1:420 S STATE COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-4119
Practice Address - Country:US
Practice Address - Phone:909-973-4086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92495-01OtherDENTI-CAL
CA764870OtherUNITED CONCORDIA PROV. #