Provider Demographics
NPI:1194933309
Name:WOODBURY, PAUL DANIEL (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DANIEL
Last Name:WOODBURY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 N CENTRAL AVE
Mailing Address - Street 2:SUITE 1401
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1959
Mailing Address - Country:US
Mailing Address - Phone:602-264-3561
Mailing Address - Fax:602-264-0053
Practice Address - Street 1:4000 N CENTRAL AVE
Practice Address - Street 2:SUITE 1401
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1959
Practice Address - Country:US
Practice Address - Phone:602-264-3561
Practice Address - Fax:602-264-0053
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4626122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist