Provider Demographics
NPI:1104186113
Name:WOOD, CHALMERS RIEGER IV (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHALMERS
Middle Name:RIEGER
Last Name:WOOD
Suffix:IV
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 1:3520 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-1505
Mailing Address - Country:US
Mailing Address - Phone:918-742-2488
Mailing Address - Fax:
Practice Address - Street 1:3520 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-1505
Practice Address - Country:US
Practice Address - Phone:918-742-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6416122300000X
MO2012016058122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist