Healthcare Provider Details

I. General information

NPI: 1467589937
Provider Name (Legal Business Name): RICHARD M. A. WOOD D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RICHARD M. A. WOOD D.M.D., P.A.

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 US HIGHWAY 27 N
AVON PARK FL
33825-9504
US

IV. Provider business mailing address

1701 US HIGHWAY 27 N
AVON PARK FL
33825-9504
US

V. Phone/Fax

Practice location:
  • Phone: 863-453-3258
  • Fax:
Mailing address:
  • Phone: 863-453-3258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN0013202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: