# DR. GORDON W WOMACK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1972600989
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 17287 | OH | — |
| 122300000X | Dentist | DGD.9455GD | SC | — |
| 1223P0221X | Pediatric Dentistry | 17287 | OH | — |
| 1223P0221X | Pediatric Dentistry | DGD.2025DS | SC | Yes |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 11/19/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0617587 | — | OH |
| 01 | — | 311367412 | FED TAX ID | OH |