Healthcare Provider Details

I. General information

NPI: 1366000903
Provider Name (Legal Business Name): MACKENZIE ELIZABETH WOOD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 W YELM AVE STE 3
YELM WA
98597-8764
US

IV. Provider business mailing address

3823 GOLDFINCH DR SE
LACEY WA
98503-7125
US

V. Phone/Fax

Practice location:
  • Phone: 360-458-5606
  • Fax:
Mailing address:
  • Phone: 360-480-6026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60955676
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: