Provider Demographics
NPI:1003641028
Name:WOODSON, DENNIS TYRONE
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:TYRONE
Last Name:WOODSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5069 CLANCY CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1290
Mailing Address - Country:US
Mailing Address - Phone:614-747-9299
Mailing Address - Fax:
Practice Address - Street 1:5069 CLANCY CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-1290
Practice Address - Country:US
Practice Address - Phone:614-747-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.005294175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist