Provider Demographics
NPI:1407993181
Name:WOOD, KYLEY ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLEY
Middle Name:ALAN
Last Name:WOOD
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 1:2005 SAINT CHARLES ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9146
Mailing Address - Country:US
Mailing Address - Phone:812-482-2280
Mailing Address - Fax:812-482-4218
Practice Address - Street 1:2005 SAINT CHARLES ST
Practice Address - Street 2:SUITE #2
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9146
Practice Address - Country:US
Practice Address - Phone:812-482-2280
Practice Address - Fax:812-482-4218
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009891A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN224140BMedicare ID - Type Unspecified
INU80114Medicare UPIN