Provider Demographics
NPI:1780396853
Name:HOOD, DYLAN LOUIS
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:LOUIS
Last Name:HOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 TANNER BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-7602
Mailing Address - Country:US
Mailing Address - Phone:573-619-1273
Mailing Address - Fax:
Practice Address - Street 1:5405 TANNER BRIDGE RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-7602
Practice Address - Country:US
Practice Address - Phone:573-619-1273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program