Provider Demographics
NPI:1649450198
Name:WOODSTOCK DENTAL CARE
Entity type:Organization
Organization Name:WOODSTOCK DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:W
Authorized Official - Last Name:LITTLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-938-3313
Mailing Address - Street 1:28716 HWY 5
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WOODSTOCK
Mailing Address - State:AL
Mailing Address - Zip Code:35188
Mailing Address - Country:US
Mailing Address - Phone:205-938-3318
Mailing Address - Fax:
Practice Address - Street 1:WOODSTOCK DENTAL CARE 28716 HWY 5
Practice Address - Street 2:SUITE 4
Practice Address - City:WOODSTOCK
Practice Address - State:AL
Practice Address - Zip Code:35188
Practice Address - Country:US
Practice Address - Phone:205-938-3318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL49971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL369760Medicaid