Provider Demographics
NPI:1851062913
Name:WOO DENTAL PC
Entity Type:Organization
Organization Name:WOO DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:815-469-3900
Mailing Address - Street 1:9975 W LINCOLN HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-2048
Mailing Address - Country:US
Mailing Address - Phone:815-469-3900
Mailing Address - Fax:
Practice Address - Street 1:9975 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-2049
Practice Address - Country:US
Practice Address - Phone:415-298-0819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental