Provider Demographics
NPI:1275034282
Name:WOOD, JENNIFER PUREFOY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:PUREFOY
Last Name:WOOD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12352 COFFEEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MITCHELLS
Mailing Address - State:VA
Mailing Address - Zip Code:22729-2046
Mailing Address - Country:US
Mailing Address - Phone:540-317-4303
Mailing Address - Fax:
Practice Address - Street 1:12352 COFFEEWOOD DR
Practice Address - Street 2:
Practice Address - City:MITCHELLS
Practice Address - State:VA
Practice Address - Zip Code:22729-2046
Practice Address - Country:US
Practice Address - Phone:540-317-4303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-25
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist