Provider Demographics
NPI:1831316793
Name:WOODRUFF, MARSHA K (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:K
Last Name:WOODRUFF
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 1:104 CALVIN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:604 N UNION ST
Practice Address - Street 2:SUITE 4
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-1570
Practice Address - Country:US
Practice Address - Phone:217-732-4307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-016348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist