Provider Demographics
NPI:1184174393
Name:WOODMENCEY, DEAN
Entity type:Individual
Prefix:MR
First Name:DEAN
Middle Name:
Last Name:WOODMENCEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 WEST LAKE CREEK DR.
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:WY
Mailing Address - Zip Code:83014
Mailing Address - Country:US
Mailing Address - Phone:307-734-9005
Mailing Address - Fax:
Practice Address - Street 1:4030 WEST LAKE CREEK DR.
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83014
Practice Address - Country:US
Practice Address - Phone:307-734-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist