Provider Demographics
NPI:1699755371
Name:WOODWARD, REBECCA J (DMD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WELLS ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2998
Mailing Address - Country:US
Mailing Address - Phone:401-596-0888
Mailing Address - Fax:401-596-9710
Practice Address - Street 1:11 WELLS ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2998
Practice Address - Country:US
Practice Address - Phone:401-596-0888
Practice Address - Fax:401-596-9710
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI23971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEN999OtherMASHANTUCKET PEQUOT
854676OtherUNITED CONCORDIA
RIRW00551Medicaid
8995-7OtherBLUE CROSS