Provider Demographics
NPI:1780139485
Name:JOHN G. WOOD, DDS
Entity type:Organization
Organization Name:JOHN G. WOOD, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:POMMERENING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-561-2400
Mailing Address - Street 1:20100 N 51ST AVE
Mailing Address - Street 2:SUITE E-550
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5125
Mailing Address - Country:US
Mailing Address - Phone:623-561-2400
Mailing Address - Fax:623-561-2425
Practice Address - Street 1:20100 N 51ST AVE
Practice Address - Street 2:SUITE E-550
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5125
Practice Address - Country:US
Practice Address - Phone:623-561-2400
Practice Address - Fax:623-561-2425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ95161223G0001X
AZ32191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty