Provider Demographics
NPI:1366000903
Name:WOOD, MACKENZIE ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:ELIZABETH
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 1:3823 GOLDFINCH DR SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-7125
Mailing Address - Country:US
Mailing Address - Phone:360-480-6026
Mailing Address - Fax:
Practice Address - Street 1:718 W YELM AVE STE 3
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8764
Practice Address - Country:US
Practice Address - Phone:360-458-5606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60955676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist