Provider Demographics
NPI:1861580276
Name:WOODS, KIMBERLY RUTH (DMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:RUTH
Last Name:WOODS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:WOODS
Other - Last Name:MONTOYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:ACL INDIAN HOSP (IHS) ATTN BUSINESS OFFICE
Mailing Address - City:SAN FIDEL
Mailing Address - State:NM
Mailing Address - Zip Code:87049
Mailing Address - Country:US
Mailing Address - Phone:505-552-6644
Mailing Address - Fax:505-552-5490
Practice Address - Street 1:STATE RD 124
Practice Address - Street 2:LAGUNA DENTAL CLINIC
Practice Address - City:NEW LAGUNA
Practice Address - State:NM
Practice Address - Zip Code:87038
Practice Address - Country:US
Practice Address - Phone:505-552-6645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH3451Medicaid
NMH3451Medicaid
NM56237804Medicaid