Provider Demographics
NPI:1952347437
Name:CLEMENT B WOODARD DDS PA
Entity Type:Organization
Organization Name:CLEMENT B WOODARD DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:BENSON
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-291-7510
Mailing Address - Street 1:2401 WOOTEN BLVD SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4464
Mailing Address - Country:US
Mailing Address - Phone:252-291-7510
Mailing Address - Fax:252-291-7531
Practice Address - Street 1:2401 WOOTEN BLVD SW
Practice Address - Street 2:SUITE A
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4464
Practice Address - Country:US
Practice Address - Phone:252-291-7510
Practice Address - Fax:252-291-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3744261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental