Provider Demographics
NPI:1619663051
Name:WOODBURY, MARK CARLYLE (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:CARLYLE
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 1:8276 MOSBY WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-5692
Mailing Address - Country:US
Mailing Address - Phone:801-712-7403
Mailing Address - Fax:
Practice Address - Street 1:6620 CAMDEN BLVD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-2505
Practice Address - Country:US
Practice Address - Phone:719-631-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002062701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry