Provider Demographics
NPI:1255354544
Name:WOODARD, DAVID R (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
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 1:5010 E 68TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3323
Mailing Address - Country:US
Mailing Address - Phone:918-493-3500
Mailing Address - Fax:918-493-3502
Practice Address - Street 1:5010 E 68TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3323
Practice Address - Country:US
Practice Address - Phone:918-493-3500
Practice Address - Fax:918-249-3350
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5849122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist