Provider Demographics
NPI:1184741514
Name:WOOD, ROBERT W (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:WOOD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5640 W MAPLE RD STE 303
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3719
Mailing Address - Country:US
Mailing Address - Phone:248-851-4606
Mailing Address - Fax:248-851-2399
Practice Address - Street 1:5640 W MAPLE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-851-4606
Practice Address - Fax:248-851-2399
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI99181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice