Provider Demographics
NPI:1538884861
Name:WOODLING ORAL SURGERY PLLC
Entity type:Organization
Organization Name:WOODLING ORAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-648-9915
Mailing Address - Street 1:1422 LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5322
Mailing Address - Country:US
Mailing Address - Phone:502-648-9915
Mailing Address - Fax:
Practice Address - Street 1:4220 VALLEY RIDGE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5172
Practice Address - Country:US
Practice Address - Phone:502-648-9915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty