Joshua Woodruff, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

021003271 Issued in IL

Practice address

1125 South Harlem Avenue
Forest Park, IL 60130

Phone

(708) 386-5437

NPI assigned

Feb 18, 2014

Last updated

Jul 17, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jerry E Udelson, DDS, PC

  dba Little Teeth Big Smiles & Children's Dentistry

  • Pediatric Dentistry
  • Forest Park, IL
  • NPI 1881885127
  NPD
• Udelson Elmhurst LLC

  dba Elmhurst Dentistry for Kids

  • Dental Clinic/Center
  • Elmhurst, IL
  • NPI 1245741768
  NPD (past)
• Michael Maruri DMD PA

  dba Super Smiles Kids Dental & Orthodontics

  • Dental Clinic/Center
  • Plantation, FL
  • NPI 1730481698
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1392681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1013331644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 S HARLEM AVE",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "60130",
            "telephone_number": "708-386-5437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 SOUTH HARLEM AVENUE",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "60130",
            "telephone_number": "708-386-5437"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "323 N York St",
            "address_purpose": "LOCATION",
            "city": "Elmhurst",
            "state": "IL",
            "postal_code": "601262319",
            "country_code": "US",
            "telephone_number": "630-833-1166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOODRUFF",
        "first_name": "JOSHUA",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-02-18",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN20926",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "021003271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackie Augustus Williams, M.D.
• Khairee Williams
• Skyy Derajane Williams, RBT
• Julianna Elizabeth Holzer Winter
• Vanessa Wittich
• Tiffany M Woods, LCPC
• Cassie Rose Yoder, M.A., LPC
• Michelle Marie Zadelek, M.A.

• Pediatric Dentistry in Forest Park, IL
• Providers in Forest Park, IL by specialty
• Pediatric Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.