Healthcare Provider Details

I. General information

NPI: 1467773721
Provider Name (Legal Business Name): EDMOND WOO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 PERRY AVE
KENSINGTON MD
20895-2118
US

IV. Provider business mailing address

3704 PERRY AVE
KENSINGTON MD
20895-2118
US

V. Phone/Fax

Practice location:
  • Phone: 301-933-1833
  • Fax:
Mailing address:
  • Phone: 301-933-1833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14849
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: