Provider Demographics
NPI:1598893240
Name:NELSON G. WOO, D.M.D., P.C.
Entity Type:Organization
Organization Name:NELSON G. WOO, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST,OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:G
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-665-0211
Mailing Address - Street 1:1906 SHILOH VALLEY TRL NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7575
Mailing Address - Country:US
Mailing Address - Phone:678-665-0211
Mailing Address - Fax:
Practice Address - Street 1:147 REINHARDT COLLEGE PARKWAY
Practice Address - Street 2:SUITE 10
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114
Practice Address - Country:US
Practice Address - Phone:770-345-3051
Practice Address - Fax:770-345-3071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0121791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty