Mark William Wooddy, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

60010 Issued in KS

Practice address

4600 W 89TH St
Prairie Village, KS 66207-2251

Phone

(913) 642-8811

Fax

(913) 642-8813

NPI assigned

Jan 8, 2006

Last updated

Oct 24, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

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": "1136678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1932187093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 W 89TH ST",
            "city": "PRAIRIE VILLAGE",
            "state": "KS",
            "postal_code": "662072251",
            "telephone_number": "913-642-8811",
            "fax_number": "913-642-8813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 W 89TH ST",
            "city": "PRAIRIE VILLAGE",
            "state": "KS",
            "postal_code": "662072251",
            "telephone_number": "913-642-8811",
            "fax_number": "913-642-8813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODDY",
        "first_name": "MARK",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-08",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KS",
            "license": "60010",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2000150743",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "410236",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "60010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Winter
• Kimberly Anne Wise, MD
• Robert Paul Wolf, DDS
• Heather Gagnon Wong, MS PT
• Orria C Wood
• Meredith Lynn Woodring, M.S. CCC-SLP
• Sara Worley, PHARMD
• Elizabeth Wroe
• Sergio M Zaderenko, MD
• Adriana Maria Zavala

• General Practice Dentistry in Prairie Village, KS
• Providers in Prairie Village, KS by specialty
• General Practice Dentistry in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 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.