Provider Demographics
NPI:1619141801
Name:ASSOCIATED CHILDREN'S DENTISTRY, PLLC
Entity Type:Organization
Organization Name:ASSOCIATED CHILDREN'S DENTISTRY, PLLC
Other - Org Name:ERIC K. WOOD, SR., DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-859-9994
Mailing Address - Street 1:206 RIVERGATE PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2033
Mailing Address - Country:US
Mailing Address - Phone:615-859-9994
Mailing Address - Fax:615-859-9939
Practice Address - Street 1:206 RIVERGATE PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2033
Practice Address - Country:US
Practice Address - Phone:615-859-9994
Practice Address - Fax:615-859-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000037151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3225308Medicaid
TNDS0000003715OtherTN STATE LICENSE