Provider Demographics
NPI:1144567900
Name:WOOD, MELISSA ELLIOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ELLIOTT
Last Name:WOOD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11809 SHERBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-1822
Mailing Address - Country:US
Mailing Address - Phone:443-465-6764
Mailing Address - Fax:
Practice Address - Street 1:4 RESERVOIR CIR STE 100
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-6360
Practice Address - Country:US
Practice Address - Phone:410-484-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-13
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD152371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice