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General NPI Number Information
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NPI Number | 1457722787
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Entity Type | Organization
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Legal Business Name | SUSAN WOOD ENDODONTICS, PLLC
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Dates
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Enumeration Date | 10/13/2015
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 10555 N TATUM BLVD STE A102
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-1096
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Country | US
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Telephone | 480-791-2733
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Fax | 480-701-8400
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Provider Business Mailing Address
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Address Line | 10555 N TATUM BLVD STE A102
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-1096
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Country | US
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Telephone | 480-483-9001
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Fax | 602-246-4778
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSAN WOOD
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Credential | D.D.S.
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Telephone | 480-791-2733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 9067
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License Number State | AZ
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