Provider Demographics
NPI:1609020593
Name:WOOD, ALAN A (DMD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:A
Last Name:WOOD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 MCQUEEN SMITH RD S
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-5631
Mailing Address - Country:US
Mailing Address - Phone:334-361-0244
Mailing Address - Fax:334-361-0244
Practice Address - Street 1:474 MCQUEEN SMITH RD S
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-5631
Practice Address - Country:US
Practice Address - Phone:334-361-0244
Practice Address - Fax:334-361-0244
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1174606370OtherORGANIZATIONAL NPI