Mark Carlyle Woodbury, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DEN.00206270 Issued in CO

Practice address

6620 Camden Blvd
Fountain, CO 80817-2505

Phone

(719) 631-6136

NPI assigned

Apr 17, 2023

Last updated

Aug 13, 2025By 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 OH

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

Interoperability endpoints

• Direct secure messaging: mwoodbury278936@ehrdirect.uhhospitals.org

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

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755043200000",
    "number": "1619663051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8276 MOSBY WAY",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809085692",
            "telephone_number": "801-712-7403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6620 CAMDEN BLVD",
            "city": "FOUNTAIN",
            "state": "CO",
            "postal_code": "808172505",
            "telephone_number": "719-631-6136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODBURY",
        "first_name": "MARK",
        "middle_name": "CARLYLE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-17",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "DEN.00206270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lynn White, RDLD
• Stephanie Willard, MS RD
• Amanda Margaret Williams, LPC
• Erricka D Wilson, LMT
• Stacey Wilson, M.ED., BCBA
• Katelyn Yadao
• Shannon Yazzie-Smith
• Jennifer Ziemer
• Carrie K Zimmer, DPT
• Esther Zody

• Pediatric Dentistry in Fountain, CO
• Providers in Fountain, CO by specialty
• Pediatric Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2025; 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.