MEDICARE: DR. DIANA PEARIS WOOD DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	AL3561	AL

General Provider Information

NPI Number	:	1689888372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA PEARIS WOOD DMD

Provider Business Mailing Address
First Line	:	3020 BRIARCLIFF RD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35223-1303
Country	:	US
Telephone Number	:	205-967-9211
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 MONTGOMERY HWY
Second Line	:	SUITE 201
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-1862
Country	:	US
Telephone Number	:	205-822-2808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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