Provider Demographics
NPI:1528194347
Name:WOOD, LEIGHTON W (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LEIGHTON
Middle Name:W
Last Name:WOOD
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8 SHERIDAN SQ STE 400
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7479
Mailing Address - Country:US
Mailing Address - Phone:423-392-9898
Mailing Address - Fax:423-392-0731
Practice Address - Street 1:8 SHERIDAN SQUARE
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7387
Practice Address - Country:US
Practice Address - Phone:423-392-9898
Practice Address - Fax:423-392-0731
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics