Healthcare Provider Details

I. General information

NPI: 1194971952
Provider Name (Legal Business Name): ROBERT ADAMS WOOD D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11607 BRAE VLY
SAN ANTONIO TX
78249-3852
US

IV. Provider business mailing address

11607 BRAE VLY
SAN ANTONIO TX
78249-3852
US

V. Phone/Fax

Practice location:
  • Phone: 801-403-5712
  • Fax:
Mailing address:
  • Phone: 801-403-5712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberUTSA 855-X
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: