Provider Demographics
NPI:1306127147
Name:WOODARD, LANCE EDWARD (DDS)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:EDWARD
Last Name:WOODARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S E JOHN JONES DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028
Mailing Address - Country:US
Mailing Address - Phone:817-447-3535
Mailing Address - Fax:
Practice Address - Street 1:225 S E JOHN JONES DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028
Practice Address - Country:US
Practice Address - Phone:817-447-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17833122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist