Provider Demographics
NPI:1770637563
Name:WOOD, ROGER ENOCH (DDS)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:ENOCH
Last Name:WOOD
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:11601 ROBIOUS ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113
Mailing Address - Country:US
Mailing Address - Phone:804-794-3498
Mailing Address - Fax:804-794-8344
Practice Address - Street 1:11601 ROBIOUS ROAD
Practice Address - Street 2:SUITE 130
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113
Practice Address - Country:US
Practice Address - Phone:804-794-3498
Practice Address - Fax:804-794-8344
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA04010049541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry