Provider Demographics
NPI:1275608945
Name:WOO, TONY (DDS)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:WOO
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 1:92 HIGH ST
Mailing Address - Street 2:UNIT DH 26
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3850
Mailing Address - Country:US
Mailing Address - Phone:781-306-0001
Mailing Address - Fax:781-306-9898
Practice Address - Street 1:92 HIGH ST.
Practice Address - Street 2:UNIT DH 26
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155
Practice Address - Country:US
Practice Address - Phone:781-306-0001
Practice Address - Fax:781-306-9898
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA189471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANX4165Medicare PIN