Provider Demographics
NPI:1235874553
Name:WOOD, TARA MAE (RDH)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:MAE
Last Name:WOOD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:TARA
Other - Middle Name:MAE
Other - Last Name:BUNCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2050 TILDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-3613
Mailing Address - Country:US
Mailing Address - Phone:315-737-2466
Mailing Address - Fax:
Practice Address - Street 1:2050 TILDEN AVE
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413
Practice Address - Country:US
Practice Address - Phone:315-737-2466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026236124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist