Organization Name: | RICHARD M. A. WOOD DMD, PA |
NPI Number: | 1508012246 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICHARD M. A. WOOD (PRESIDENT) |
Mailing Address: | 1701 Us Highway 27 N Avon Park |
State: | FL US |
Postal Code: | 338259504 |
Phone Number: | 8634533258 |
Fax Number: | 8634520460 |
NPI Enumeration Date: | 08/13/2008 |
NPI Last Update Date: | 08/13/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | DN013202 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |