Provider Demographics
NPI:1700062874
Name:WOOD, TONI MAIRE (RDH)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:MAIRE
Last Name:WOOD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 E LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-2222
Mailing Address - Country:US
Mailing Address - Phone:660-263-6643
Mailing Address - Fax:
Practice Address - Street 1:423 E LOGAN ST
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-2222
Practice Address - Country:US
Practice Address - Phone:660-263-6643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000157249124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist