Provider Demographics
NPI:1760369953
Name:WOOD, DOMINIK MICHAEL
Entity type:Individual
Prefix:
First Name:DOMINIK
Middle Name:MICHAEL
Last Name:WOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-2107
Mailing Address - Country:US
Mailing Address - Phone:304-650-6825
Mailing Address - Fax:
Practice Address - Street 1:1005 7TH ST
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-2107
Practice Address - Country:US
Practice Address - Phone:304-650-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant