Healthcare Provider Details

I. General information

NPI: 1699185538
Provider Name (Legal Business Name): JASON WOOD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 FRONT ST
GEORGETOWN SC
29440-3624
US

IV. Provider business mailing address

280 N GROVE MEDICAL PARK DR
SPARTANBURG SC
29303-4222
US

V. Phone/Fax

Practice location:
  • Phone: 843-699-2500
  • Fax:
Mailing address:
  • Phone: 864-585-3318
  • Fax: 804-828-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8440
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: