Provider Demographics
NPI:1790479566
Name:WOOD, ROSANNE MARIE (RDHAP)
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:MARIE
Last Name:WOOD
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9311 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451-9522
Mailing Address - Country:US
Mailing Address - Phone:707-350-4544
Mailing Address - Fax:
Practice Address - Street 1:9311 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:KELSEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95451-9522
Practice Address - Country:US
Practice Address - Phone:707-350-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP987124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist