Provider Demographics
NPI:1316161995
Name:WOODARD, BRIAN EMERSON (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EMERSON
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 1:3330 PARK STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2654
Mailing Address - Country:US
Mailing Address - Phone:614-875-9500
Mailing Address - Fax:
Practice Address - Street 1:3330 PARK ST
Practice Address - Street 2:SUITE B
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2654
Practice Address - Country:US
Practice Address - Phone:614-875-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist