Active NPI
Jon Michael Woodruff, DDS
- General Practice Dentistry
- Philadelphia, PA
National Provider Identifier
1366435331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS044372
- Practice address
- 861 E Allegheny Ave
Philadelphia, PA 19134-2401 - Phone
- (215) 302-3156
- Fax
- (215) 329-2369
- NPI assigned
- Aug 25, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6814 | KS | |
| Dentist | 122300000X | DS044372 | PA | |
| General Practice Dentistry | 1223G0001X | DS044372 | PA | Primary |
Addresses
Primary practice location
861 E Allegheny Ave
Philadelphia, PA 19134-2401
Mailing address
861 E Allegheny Ave
Philadelphia, PA 19134-2401
Phone (215) 302-3156
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100225410-B | Medicaid | KS | |
| 017363 | Other | KS | BLUE CROSS BLUE SHIELD |
| 1042785600001 | Medicaid | PA | |
| 000781486 | Other | UNITED CONCORDIA OF KS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6814 | KS | MD | Dentist |
| DS044372 | PA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738281600000",
"number": "1366435331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "861 E ALLEGHENY AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191342401",
"telephone_number": "215-302-3156",
"fax_number": "215-329-2369"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "861 E ALLEGHENY AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191342401",
"telephone_number": "215-302-3156",
"fax_number": "215-329-2369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODRUFF",
"first_name": "JON",
"middle_name": "MICHAEL",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-25",
"last_updated": "2025-01-31",
"certification_date": "2025-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KS",
"license": "6814",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS044372",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PA",
"license": "DS044372",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100225410-B",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "017363",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1042785600001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA OF KS",
"identifier": "000781486",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.