Individual
MRS. JENNIFER LIEN WOODSIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
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 DENTAL
—
01
—
186781
ANTHEM
—
Enumeration date
11/27/2006
Last updated
07/08/2007
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