Healthcare Provider Details

I. General information

NPI: 1679333801
Provider Name (Legal Business Name): ETHAN CURTIS WOOD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 WINCHESTER ST
KEENE NH
03431-4634
US

IV. Provider business mailing address

103 ORCHARD LN UNIT 302
SWANZEY NH
03446-2163
US

V. Phone/Fax

Practice location:
  • Phone: 603-354-3895
  • Fax:
Mailing address:
  • Phone: 716-490-8220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number05381
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: