Provider Demographics
NPI:1942572391
Name:DOUGLAS G. WOODSON, DDS PLLC
Entity type:Organization
Organization Name:DOUGLAS G. WOODSON, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-232-8743
Mailing Address - Street 1:228 ROBERT S KERR AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-5217
Mailing Address - Country:US
Mailing Address - Phone:405-232-8743
Mailing Address - Fax:405-232-2309
Practice Address - Street 1:228 ROBERT S KERR AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-5217
Practice Address - Country:US
Practice Address - Phone:405-232-8743
Practice Address - Fax:405-232-2309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK41541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty