Provider Demographics
NPI:1942229273
Name:WOO, DONNA JEANETTE (DDS)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEANETTE
Last Name:WOO
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 1:420 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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA562282812OtherTAX ID#
CA764870OtherUNITED CONCORDIA PROVIDER
CAG92495-01Medicaid