Lesa Rae Woodson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

59194 Issued in CA

Practice address

2400 Maritime Dr
Elk Grove, CA 95758-3660

Phone

(916) 686-8914

NPI assigned

Feb 27, 2007

Last updated

Oct 27, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Lesa Rae Williams Former name

Medicare fee-for-service enrollment

Enrolled in CA

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

Locations

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.

• Northstate Dental

  • General Practice Dentistry
  • Elk Grove, CA
  • NPI 1619758091
  NPD
• Northstate Dental University Program

  • General Practice Dentistry
  • Elk Grove, CA
  • NPI 1588498133
  NPD

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1063549228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10259 PEDRA DO SOL CT",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957573475",
            "telephone_number": "916-936-5154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 MARITIME DR",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957583660",
            "telephone_number": "916-686-8914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODSON",
        "first_name": "LESA",
        "middle_name": "RAE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-27",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "59194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1856088",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LESA",
            "last_name": "WILLIAMS",
            "middle_name": "RAE",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alton Wayne Wood, LCSW
• Gregory Wood, LMFT
• Angela Marie Woodrum, RN
• Woods Care Home, Inc (Diamond Oak Guest Home)
• Faith Woods
• Janice Rene Work, DDS
• Worldwide Trade & Consulting Inc
• Joshua Wormley
• Theresa Adria Worsham, DMD
• Patricia Worth

• Dentist in Elk Grove, CA
• Providers in Elk Grove, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2023; 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.