Evan Woodford

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12851 Issued in CT

Practice address

817 Boston Post Rd
Madison, CT 06443-3155

Phone

(203) 245-4266

NPI assigned

Mar 21, 2019

Last updated

Oct 3, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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": "1553126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696291200000",
    "number": "1427518836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 BOSTON POST RD",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064433155",
            "telephone_number": "203-245-4266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 BOSTON POST RD",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064433155",
            "telephone_number": "203-245-4266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODFORD",
        "first_name": "EVAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-21",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "12851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Elizabeth Whalen
• Gail Barbara Whitman, M.D.
• Wildwood Behavioral Health, LLC
• Patrice M Wilhelm, APRN
• Elizabeth Wilson, LMFT
• Scott H. Woodford, DMD
• Brandon Wright
• Shannon Wynne, LCSW
• Leah M Yazmer, CCLS
• Linda L. Young, LCSW

• General Practice Dentistry in Madison, CT
• Providers in Madison, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 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.