Provider Demographics
NPI:1821773599
Name:WOODWORTH, BROOKLYN ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:BROOKLYN
Middle Name:ELIZABETH
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-2945
Mailing Address - Country:US
Mailing Address - Phone:479-267-5009
Mailing Address - Fax:
Practice Address - Street 1:181 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-2945
Practice Address - Country:US
Practice Address - Phone:479-267-5009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist