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General NPI Number Information
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NPI Number | 1144772740
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Entity Type | Organization
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Legal Business Name | SPECIALITY DENTAL PARTNERS OF VIRGINIA PLLC
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Dates
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Enumeration Date | 10/30/2016
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Last Update Date | 10/30/2016
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Provider Practice Location Address
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Address Line | 125 HELLE BLVD SUITE A
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City | DUNDEE
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State | MI
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Zip | 48131-9594
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Country | US
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Telephone | 734-348-5222
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Fax |
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Provider Business Mailing Address
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Address Line | 125 HELLE BLVD SUITE A
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City | DUNDEE
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State | MI
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Zip | 48131-9594
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Country | US
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Telephone | 734-348-5222
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. ROGER WOOD
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Credential |
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Telephone | 734-348-5222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0401004954
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License Number State | VA
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