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General NPI Number Information
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NPI Number | 1942322755
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Entity Type | Individual
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Provider Name | SUSAN LARAE WOOD DDS
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Gender | Female
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Dates
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Enumeration Date | 04/04/2007
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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 | 807-912-7334
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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 | 480-438-4334
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Fax | 505-819-5691
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D009067
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License Number State | AZ
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