Provider Demographics
NPI:1376277517
Name:WOODS, DILLON TYLER (DDS)
Entity type:Individual
Prefix:DR
First Name:DILLON
Middle Name:TYLER
Last Name:WOODS
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 1:3549 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-5641
Mailing Address - Country:US
Mailing Address - Phone:712-328-0708
Mailing Address - Fax:
Practice Address - Street 1:3549 11TH AVE
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-5641
Practice Address - Country:US
Practice Address - Phone:712-328-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA10285122300000X
NE7806122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA10285OtherIOWA DENTAL LICENSE
NE7806OtherNEBRASKA DENTAL LICENSE