Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 203932 | CO |
NPI | 1003220260 |
---|---|
Provider Name | Dr. Michael Woodbeck |
First Address | Denver, CO 80202-6505 |
Second Address | Denver, CO 80202-6505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2014 |
Last Update Date | 01/10/2020 |