Provider Demographics
NPI:1982150058
Name:WOODERSON, MONICA DAGOSITINI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:DAGOSITINI
Last Name:WOODERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 S WASHINGTON AVE
Mailing Address - Street 2:UNIT 907
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3854
Mailing Address - Country:US
Mailing Address - Phone:248-941-4509
Mailing Address - Fax:
Practice Address - Street 1:432 S WASHINGTON AVE
Practice Address - Street 2:UNIT 907
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3854
Practice Address - Country:US
Practice Address - Phone:248-941-4509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022048122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist