Provider Demographics
NPI:1871639161
Name:WOODS, DAVID DEAN (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DEAN
Last Name:WOODS
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4133 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4316
Mailing Address - Country:US
Mailing Address - Phone:904-737-3617
Mailing Address - Fax:904-737-8326
Practice Address - Street 1:115 PROFESSIONAL DR
Practice Address - Street 2:#105
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082-6259
Practice Address - Country:US
Practice Address - Phone:904-280-4006
Practice Address - Fax:904-737-8326
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN00122271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL69228AMedicare PIN