Organization
WOODSIDE PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L. WOODSIDE (DENTIST)
(540) 341-0014
Entity
Organization
Contact information
Practice address
400 HOLIDAY CT, SUITE 107, WARRENTON, VA 20186-4349
(540) 341-0014
(540) 341-0303
Mailing address
400 HOLIDAY CT, SUITE 107, WARRENTON, VA 20186-4349
(540) 341-0014
(540) 341-0303
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
0401411006
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107966
—
VA
01
—
1777507
UNITED CONCORDIA
VA
01
—
186781
ANTHEM DENTAL
VA
Enumeration date
01/29/2007
Last updated
06/16/2008
Update your record
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