Provider Demographics
NPI:1942575832
Name:JEREMY D. WOOD, D.M.D, PC
Entity Type:Organization
Organization Name:JEREMY D. WOOD, D.M.D, PC
Other - Org Name:DARBY DENTAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-537-3377
Mailing Address - Street 1:310 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-4708
Mailing Address - Country:US
Mailing Address - Phone:912-537-3377
Mailing Address - Fax:912-538-7010
Practice Address - Street 1:310 JACKSON ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4708
Practice Address - Country:US
Practice Address - Phone:912-537-3377
Practice Address - Fax:912-538-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0139061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty