Provider Demographics
NPI:1225104862
Name:WOOD, JOHN ANDREW (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDREW
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 1:102 LOREY DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-7032
Mailing Address - Country:US
Mailing Address - Phone:970-242-4945
Mailing Address - Fax:970-242-0954
Practice Address - Street 1:102 LOREY DRIVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-7032
Practice Address - Country:US
Practice Address - Phone:970-242-4945
Practice Address - Fax:970-242-0954
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8861122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist