Provider Demographics
NPI:1295933513
Name:WOODS, MATTHEW DALE (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DALE
Last Name:WOODS
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 1:170 HORIZON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-272-5918
Mailing Address - Fax:
Practice Address - Street 1:105 PROVIDENCE MINE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2950
Practice Address - Country:US
Practice Address - Phone:530-265-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-08
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist