Provider Demographics
NPI:1770138513
Name:RDW2 DENTAL GROUP
Entity type:Organization
Organization Name:RDW2 DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-586-4160
Mailing Address - Street 1:6327 THOMAS JEFFREY
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-5037
Mailing Address - Country:US
Mailing Address - Phone:615-586-4160
Mailing Address - Fax:
Practice Address - Street 1:989 N 4TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3666
Practice Address - Country:US
Practice Address - Phone:615-586-4160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental