Provider Demographics
NPI:1871109850
Name:WOODDELL, JAMES BANTZ JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BANTZ
Last Name:WOODDELL
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 LONDONTOWN RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2120
Mailing Address - Country:US
Mailing Address - Phone:410-703-3639
Mailing Address - Fax:
Practice Address - Street 1:600 RIDGELY AVE STE 225
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1089
Practice Address - Country:US
Practice Address - Phone:410-224-9608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice