Provider Demographics
NPI:1386074490
Name:MCKENZIE RAYMOND WOODARD, DDS LLC
Entity type:Organization
Organization Name:MCKENZIE RAYMOND WOODARD, DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:MCKENZIE RAYMOND
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-387-7108
Mailing Address - Street 1:500 BUCKSLEY LN UNIT 207
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8182
Mailing Address - Country:US
Mailing Address - Phone:804-387-7108
Mailing Address - Fax:
Practice Address - Street 1:159 WENTWORTH ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1731
Practice Address - Country:US
Practice Address - Phone:843-577-2898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty