Provider Demographics
NPI:1821181447
Name:DON C WOOD JR DDS INC
Entity Type:Organization
Organization Name:DON C WOOD JR DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-828-4010
Mailing Address - Street 1:5352 LINCOLN AVE.
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630
Mailing Address - Country:US
Mailing Address - Phone:714-828-4010
Mailing Address - Fax:
Practice Address - Street 1:5352 LINCOLN AVE.
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630
Practice Address - Country:US
Practice Address - Phone:714-828-4010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA322071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6363750001Medicare NSC