# JON M. WOODRUFF, D.D.S.;P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083668933
- **Authorized official:** DR. JON MICHAEL WOODRUFF D.D.S. (OWNER/PRESIDENT)
- **Authorized official phone:** (316) 684-7531

## Contact information

- **Practice address:** 910 S HILLSIDE ST, WICHITA, KS 67211-4001
- **Practice address phone:** (316) 684-7531
- **Practice address fax:** (316) 684-1824
- **Mailing address:** 910 S HILLSIDE ST, WICHITA, KS 67211-4001
- **Mailing address phone:** (316) 684-7531
- **Mailing address fax:** (316) 684-1824

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6814 | KS | Yes |

## Other

- **Enumeration date:** 05/22/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 017363 | BCBS OF KS | KS |