Healthcare Provider Details

I. General information

NPI: 1720779390
Provider Name (Legal Business Name): WOOD AND HABASHY DENTAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 GREENLEAF AVE
WHITTIER CA
90601-4110
US

IV. Provider business mailing address

6711 GREENLEAF AVE
WHITTIER CA
90601-4110
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-0054
  • Fax:
Mailing address:
  • Phone: 562-698-0054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MARK WOOD
Title or Position: PARTNER
Credential: DDS
Phone: 248-770-0411