Provider Demographics
NPI:1982759742
Name:WOOD, RICHARD CRAIG I (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CRAIG
Last Name:WOOD
Suffix:I
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WAMPANOAG TRL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-1511
Mailing Address - Country:US
Mailing Address - Phone:401-434-2626
Mailing Address - Fax:401-434-2799
Practice Address - Street 1:600 WAMPANOAG TRL
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-1511
Practice Address - Country:US
Practice Address - Phone:401-434-2626
Practice Address - Fax:401-434-2799
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI15241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice