Provider Demographics
NPI:1376561712
Name:WOOD, HORACE KENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:HORACE
Middle Name:KENT
Last Name:WOOD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 C CYNWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3805
Mailing Address - Country:US
Mailing Address - Phone:410-770-3130
Mailing Address - Fax:410-770-5422
Practice Address - Street 1:508 C CYNWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3805
Practice Address - Country:US
Practice Address - Phone:410-770-3130
Practice Address - Fax:410-770-5422
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2903122300000X
MD113311223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U43314Medicare UPIN
V569Medicare ID - Type Unspecified