=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760556849
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHILIP M WOO JR DMD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 171 LOVELL AVE SUITE 101
-----------------------------------------------------
City | EBENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-472-4644
-----------------------------------------------------
Fax | 814-472-4588
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 171 LOVELL AVE SUITE 101
-----------------------------------------------------
City | EBENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-472-4644
-----------------------------------------------------
Fax | 814-472-4588
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. PHILIP M WOO JR.
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 814-472-4644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS023541L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------