Provider Demographics
NPI:1679832638
Name:WOOD, RYAN LADELL (DDS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LADELL
Last Name:WOOD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 E ALDER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2073
Mailing Address - Country:US
Mailing Address - Phone:509-522-0790
Mailing Address - Fax:509-529-1094
Practice Address - Street 1:614 E ALDER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2073
Practice Address - Country:US
Practice Address - Phone:509-522-0790
Practice Address - Fax:509-529-1094
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602758961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics