Individual provider Active NPI

Wyman Richard Woodward, DDS

  • General Practice Dentistry
  • Jacksonville, FL
National Provider Identifier
1932255320
Registry record updated Nov 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN7977 Issued in FL
Practice address
9000 Golfside Drive
Suite B
Jacksonville, FL 32256-7793
Phone
(904) 731-4343
Fax
(904) 731-2783
NPI assigned
Jan 26, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN7977 FL Primary

Addresses

Primary practice location

9000 Golfside Drive
Suite B
Jacksonville, FL 32256-7793

Mailing address

9000 Golfside Drive
Suite B
Jacksonville, FL 32256-7793
Phone (904) 367-1722

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20160115002330 FL Order and Referring Only - DentistPractitioner - Dentist 9739482266

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Smilecare Dental Associates PA Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288569600000",
    "number": "1932255320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 GOLFSIDE DRIVE",
            "address_2": "SUITE B",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322567793",
            "telephone_number": "904-367-1722",
            "fax_number": "904-367-1739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 GOLFSIDE DRIVE",
            "address_2": "SUITE B",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322567793",
            "telephone_number": "904-731-4343",
            "fax_number": "904-731-2783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODWARD",
        "first_name": "WYMAN",
        "middle_name": "RICHARD",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2010-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN7977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.