Provider Demographics
NPI:1972021350
Name:WOODMAN, CYNTHIA SUSANNE (RDH, APDH)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:SUSANNE
Last Name:WOODMAN
Suffix:
Gender:F
Credentials:RDH, APDH
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 937
Mailing Address - Street 2:
Mailing Address - City:PIMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85543-0937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:168 S. 900 W.
Practice Address - Street 2:
Practice Address - City:PIMA
Practice Address - State:AZ
Practice Address - Zip Code:85543-8554
Practice Address - Country:US
Practice Address - Phone:928-965-1534
Practice Address - Fax:928-965-1534
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist