Individual
DR. TODD E WYNKOOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
12510 LAKE RIDGE DR STE C, WOODBRIDGE, VA 22192-7501
(703) 494-8624
(703) 497-1258
Mailing address
12510 LAKE RIDGE DR STE C, WOODBRIDGE, VA 22192-7501
(703) 494-8624
(703) 497-1258
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
0401007464
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401007464
BLUE CROSS BLUE SHIELD
VA
01
—
872859
UNITED CONCORDIA
PA
Enumeration date
07/29/2006
Last updated
07/15/2008
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