Provider Demographics
NPI:1245960012
Name:WOODWARD, MCKENNA JO (DDS)
Entity type:Individual
Prefix:DR
First Name:MCKENNA
Middle Name:JO
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MCKENNA
Other - Middle Name:JO
Other - Last Name:KILBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1210 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-4085
Mailing Address - Country:US
Mailing Address - Phone:319-730-7300
Mailing Address - Fax:
Practice Address - Street 1:1210 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-4085
Practice Address - Country:US
Practice Address - Phone:319-730-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-099951223G0001X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice