Healthcare Provider Details

I. General information

NPI: 1851281471
Provider Name (Legal Business Name): SAMANTHA WOOD BSDH, OMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6328 MALVEY AVE
FORT WORTH TX
76116-4509
US

IV. Provider business mailing address

6328 MALVEY AVE
FORT WORTH TX
76116-4509
US

V. Phone/Fax

Practice location:
  • Phone: 817-781-3350
  • Fax:
Mailing address:
  • Phone: 817-781-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number21351
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: