Provider Demographics
NPI:1205570876
Name:WOOD, AYANNA BRINEA (RDH)
Entity type:Individual
Prefix:
First Name:AYANNA
Middle Name:BRINEA
Last Name:WOOD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:AYANNA
Other - Middle Name:BRINEA
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:15421 WEST ST APT A
Mailing Address - Street 2:
Mailing Address - City:FORT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459-2943
Mailing Address - Country:US
Mailing Address - Phone:240-640-3786
Mailing Address - Fax:
Practice Address - Street 1:3709 MASONIC DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3632
Practice Address - Country:US
Practice Address - Phone:318-269-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5352124Q00000X
MD8398124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental Hygienist