Provider Demographics
NPI:1508012246
Name:RICHARD M. A. WOOD DMD, PA
Entity Type:Organization
Organization Name:RICHARD M. A. WOOD DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M A
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:863-453-3258
Mailing Address - Street 1:1701 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-9504
Mailing Address - Country:US
Mailing Address - Phone:863-453-3258
Mailing Address - Fax:863-452-0460
Practice Address - Street 1:1701 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-9504
Practice Address - Country:US
Practice Address - Phone:863-453-3258
Practice Address - Fax:863-452-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN013202261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1467589937OtherNPPES(INDIVIDUAL)