Provider Demographics
NPI:1740463819
Name:WOODARD, MONICA (DDS MDS)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:WOODARD
Suffix:
Gender:F
Credentials:DDS MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5833 HARBOUR VIEW BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435
Mailing Address - Country:US
Mailing Address - Phone:757-686-3955
Mailing Address - Fax:757-686-3959
Practice Address - Street 1:5833 HARBOUR VIEW BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435
Practice Address - Country:US
Practice Address - Phone:757-686-3955
Practice Address - Fax:757-686-3959
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014111381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9180412Medicaid