Provider Demographics
NPI:1114330503
Name:WOOD, EDWARD W (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:W
Last Name:WOOD
Suffix:
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 1:1321 OBERLIN RD STE B
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2052
Mailing Address - Country:US
Mailing Address - Phone:919-696-2219
Mailing Address - Fax:
Practice Address - Street 1:1321 OBERLIN RD STE B
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-2052
Practice Address - Country:US
Practice Address - Phone:919-696-2219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice