Russell Glenn Woodson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

28412 Issued in CA

Practice address

155 5TH St
San Francisco, CA 94103-2919

Phone

(415) 929-6524

Fax

(415) 929-6522

NPI assigned

May 11, 2007

Sex

Male

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

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

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476835200000",
    "number": "1124233309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 5TH ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941032919",
            "telephone_number": "415-929-6524",
            "fax_number": "415-929-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 5TH ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941032919",
            "telephone_number": "415-929-6524",
            "fax_number": "415-929-6522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODSON",
        "first_name": "RUSSELL",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-11",
        "last_updated": "2016-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "28412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID#",
            "identifier": "94-1738084",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracey E Woods
• Michael Woodsome, MSN, APRN, FNP-C
• Diamond Woodson
• Harlen Woodson I
• Jamell Katrease Woodson
• Ryan Ine Woodson, MD, MPH
• Eva De Los Angeles Woodward, M.S.W.
• Omar J Woodworth
• Sean Woolen
• Sara A. Woolf, MD

• General Practice Dentistry in San Francisco, CA
• Providers in San Francisco, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; 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.