Provider Demographics
NPI:1235797804
Name:WOOD, BRENNAN MATTHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENNAN
Middle Name:MATTHEW
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 1:119 COFFMAN APPROACH RD
Mailing Address - Street 2:
Mailing Address - City:ALDERSON
Mailing Address - State:WV
Mailing Address - Zip Code:24910-7159
Mailing Address - Country:US
Mailing Address - Phone:304-661-4565
Mailing Address - Fax:
Practice Address - Street 1:142 HOLIDAY LN
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9315
Practice Address - Country:US
Practice Address - Phone:304-645-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV43981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice