Provider Demographics
NPI:1063925410
Name:WOODWARD, KYLA (RDH)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-2111
Mailing Address - Country:US
Mailing Address - Phone:928-651-1881
Mailing Address - Fax:
Practice Address - Street 1:1517 S 20TH AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-4009
Practice Address - Country:US
Practice Address - Phone:928-348-9181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist