Provider Demographics
NPI:1982991261
Name:WOOLWINE, WOODS RAYBURN III (DDS)
Entity Type:Individual
Prefix:DR
First Name:WOODS
Middle Name:RAYBURN
Last Name:WOOLWINE
Suffix:III
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 1:155 E SONTERRA BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3989
Mailing Address - Country:US
Mailing Address - Phone:210-341-3222
Mailing Address - Fax:
Practice Address - Street 1:155 E SONTERRA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3989
Practice Address - Country:US
Practice Address - Phone:210-341-3222
Practice Address - Fax:210-341-8607
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8024940-99221223G0001X
TX305531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty