Provider Demographics
NPI:1982822391
Name:WOODLOCK, KRISTA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:
Last Name:WOODLOCK
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 1:2401 SEABOARD RD STE 106
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3500
Mailing Address - Country:US
Mailing Address - Phone:757-427-9449
Mailing Address - Fax:757-301-7542
Practice Address - Street 1:2401 SEABOARD RD STE 106
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3500
Practice Address - Country:US
Practice Address - Phone:757-427-9449
Practice Address - Fax:757-301-7542
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014105991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9182574Medicaid