Provider Demographics
NPI:1255756946
Name:WOODRUFF, LINDA RAE (RDH)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:RAE
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 CALIFORNIA PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68178-0212
Mailing Address - Country:US
Mailing Address - Phone:402-280-5041
Mailing Address - Fax:402-280-5094
Practice Address - Street 1:2500 CALIFORNIA PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68178-0212
Practice Address - Country:US
Practice Address - Phone:402-280-5041
Practice Address - Fax:402-280-5094
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1010124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist