Active NPI
Charles J Woodyard, DDS
- Dentist
- Gould, AR
National Provider Identifier
1861593410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1969
- Practice address
- 407 S Gould Ave
Gould, AR 71643-5041 - Phone
- (870) 263-4317
- Fax
- (870) 263-4782
- NPI assigned
- Sep 26, 2006
- Last updated
- Jul 23, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1969 | AR | Primary |
Addresses
Primary practice location
407 S Gould Ave
Gould, AR 71643-5041
Mailing address
407 S Gould Ave
Gould, AR 71643-5041
Phone (870) 263-4317
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 149324631 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1969 | AR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374537600000",
"number": "1861593410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "407 S GOULD AVE",
"city": "GOULD",
"state": "AR",
"postal_code": "716435041",
"telephone_number": "870-263-4317",
"fax_number": "870-263-4782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "407 S GOULD AVE",
"city": "GOULD",
"state": "AR",
"postal_code": "716435041",
"telephone_number": "870-263-4317",
"fax_number": "870-263-4782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODYARD",
"first_name": "CHARLES",
"middle_name": "J",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-26",
"last_updated": "2013-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AR",
"license": "1969",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "149324631",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gould, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; 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.