Provider Demographics
NPI:1043192990
Name:WOODLAND AMES BOYACK DESPAIN PLLC
Entity type:Organization
Organization Name:WOODLAND AMES BOYACK DESPAIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-457-5152
Mailing Address - Street 1:422 E LAURIDSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7952
Mailing Address - Country:US
Mailing Address - Phone:360-457-5152
Mailing Address - Fax:360-457-6673
Practice Address - Street 1:422 E LAURIDSEN BLVD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7952
Practice Address - Country:US
Practice Address - Phone:360-457-5152
Practice Address - Fax:360-457-6673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental