Kacie Kay Woodis, D.D.S.
Individual provider Active NPI Dentist · Isle, MN
NPI 1669736674 · NPPES record last updated Jun 25, 2012
Key facts
- NPI
- 1669736674
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D13123 (MN)
- Practice address
- 370 3Rd Ave S
Isle, MN 56342-4573 - Phone
- (320) 676-3232
- NPI assigned
- Jun 25, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D13123 | MN | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D13123 | MN | Yes |
Addresses
Primary practice location
370 3Rd Ave S
Isle, MN 56342-4573
Mailing address
10494 Pierce St NE
Blaine, MN 55434-3682
Other providers in Isle, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.