Provider Demographics
NPI:1467725879
Name:LEIGHTON W WOOD DDS MS P.C.
Entity Type:Organization
Organization Name:LEIGHTON W WOOD DDS MS P.C.
Other - Org Name:TRI-CITIES ORTHODONTIC SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGHTON
Authorized Official - Middle Name:W
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:276-642-0043
Mailing Address - Street 1:103 LINDEN SQUARE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202
Mailing Address - Country:US
Mailing Address - Phone:276-642-0043
Mailing Address - Fax:276-642-0077
Practice Address - Street 1:103 LINDEN SQUARE DRIVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202
Practice Address - Country:US
Practice Address - Phone:276-642-0043
Practice Address - Fax:276-642-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014131661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty