1861580276 NPI number — DR. KIMBERLY RUTH WOODS DMD

Table of content: DR. KIMBERLY RUTH WOODS DMD (NPI 1861580276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861580276 NPI number — DR. KIMBERLY RUTH WOODS DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODS
Provider First Name:
KIMBERLY
Provider Middle Name:
RUTH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONTOYA
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
WOODS
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1861580276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 130
Provider Second Line Business Mailing Address:
ACL INDIAN HOSP (IHS) ATTN BUSINESS OFFICE
Provider Business Mailing Address City Name:
SAN FIDEL
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-552-6644
Provider Business Mailing Address Fax Number:
505-552-5490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STATE RD 124
Provider Second Line Business Practice Location Address:
LAGUNA DENTAL CLINIC
Provider Business Practice Location Address City Name:
NEW LAGUNA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-552-6645
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DD2105 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H3451 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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