Provider Demographics
NPI:1912900846
Name:WOODS, DANA JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:JOHN
Last Name:WOODS
Suffix:
Gender:M
Credentials:DMD
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 349
Mailing Address - Street 2:
Mailing Address - City:WILLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06279-0349
Mailing Address - Country:US
Mailing Address - Phone:860-429-5084
Mailing Address - Fax:860-429-5730
Practice Address - Street 1:11 PHELPS WAY
Practice Address - Street 2:
Practice Address - City:WILLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06279-9998
Practice Address - Country:US
Practice Address - Phone:860-429-5084
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
CT7305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist