Provider Demographics
NPI:1407114648
Name:R. CRAIG WOOD, DMD, LTD.
Entity Type:Organization
Organization Name:R. CRAIG WOOD, DMD, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-434-2626
Mailing Address - Street 1:600 WAMPANOAG TRL
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-1511
Mailing Address - Country:US
Mailing Address - Phone:401-434-2626
Mailing Address - Fax:401-434-2799
Practice Address - Street 1:600 WAMPANOAG TRL
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-1511
Practice Address - Country:US
Practice Address - Phone:401-434-2626
Practice Address - Fax:401-434-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN015241223G0001X
RI016381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1982759742OtherDENTAL
1093729469OtherDENTAL