Provider Demographics
NPI:1184602815
Name:WOODARD, RICHARD A (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:WOODARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-2157
Mailing Address - Country:US
Mailing Address - Phone:785-537-2800
Mailing Address - Fax:
Practice Address - Street 1:3200 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-2157
Practice Address - Country:US
Practice Address - Phone:785-537-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS65971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice