Provider Demographics
NPI:1629228630
Name:WOOD, WILLIAM S (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
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 1:1540 HIGHWAY 138
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3763
Mailing Address - Country:US
Mailing Address - Phone:732-280-0800
Mailing Address - Fax:
Practice Address - Street 1:3205 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-4439
Practice Address - Country:US
Practice Address - Phone:732-681-2093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D101059700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist