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General NPI Number Information
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NPI Number | 1043835952
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Entity Type | Individual
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Provider Name | EMMA JOHNSON WOOD DDS
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Gender | Female
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Dates
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Enumeration Date | 06/16/2020
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | BLDG 600 MCCAIN BLVD BRANCH DENTAL CLINIC NAVAL AIR STATION NORTH ISLAND
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City | SAN DEIGO
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State | CA
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Zip | 92135
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Country | US
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Telephone | 619-545-6397
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Fax |
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Provider Business Mailing Address
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Address Line | BLDG 600 MCCAIN BLVD BRANCH DENTAL CLINIC NAVAL AIR STATION NORTH ISLAND
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City | SAN DEIGO
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State | CA
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Zip | 92135
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Country | US
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Telephone | 619-545-6397
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 11824
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License Number State | NC
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