Provider Demographics
NPI:1780719559
Name:WOODALL, HAROLD STEVE (DDS)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:STEVE
Last Name:WOODALL
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:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-0516
Mailing Address - Country:US
Mailing Address - Phone:770-459-5197
Mailing Address - Fax:770-459-5146
Practice Address - Street 1:512 W BANKHEAD HWY
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1703
Practice Address - Country:US
Practice Address - Phone:770-459-5197
Practice Address - Fax:770-459-5146
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0082401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice