Provider Demographics
NPI:1356350243
Name:WOODHOUSE, ALAN STANLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:STANLEY
Last Name:WOODHOUSE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52349
Mailing Address - Country:US
Mailing Address - Phone:319-472-3282
Mailing Address - Fax:319-472-3282
Practice Address - Street 1:207 E 4TH STREET
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:IA
Practice Address - Zip Code:52349
Practice Address - Country:US
Practice Address - Phone:319-472-3282
Practice Address - Fax:319-472-3282
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05662122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0070508Medicaid