Provider Demographics
NPI:1831286640
Name:FOUTCH, WOODARD DUFFEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:WOODARD
Middle Name:DUFFEY
Last Name:FOUTCH
Suffix:
Gender:M
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:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37861-0022
Mailing Address - Country:US
Mailing Address - Phone:865-828-5281
Mailing Address - Fax:865-828-4733
Practice Address - Street 1:7786 RUTLEDGE PIKE
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:TN
Practice Address - Zip Code:37861
Practice Address - Country:US
Practice Address - Phone:865-828-5281
Practice Address - Fax:865-828-4733
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS26311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice