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General NPI Number Information
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NPI Number | 1467457465
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Entity Type | Organization
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Legal Business Name | CENTRAL VALLEY DENTAL IMPLANT
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1116 N. CHINOWTH RD
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City | VISALIA
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State | CA
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Zip | 93291
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Country | US
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Telephone | 559-732-7946
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Fax | 559-732-9621
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Provider Business Mailing Address
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Address Line | 1116 N. CHINOWTH RD
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City | VISALIA
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State | CA
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Zip | 93291
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Country | US
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Telephone | 559-732-7946
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Fax | 559-732-9621
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Authorized Official
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Title or Position | PARTNER
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Name | DR. TERRY R WOOD
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Credential | DDS
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Telephone | 559-732-7946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 25102
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 34589
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 24419
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License Number State | CA
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