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General NPI Number Information
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NPI Number | 1942575832
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Entity Type | Organization
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Legal Business Name | JEREMY D. WOOD, D.M.D, PC
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Dates
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Enumeration Date | 03/12/2012
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Last Update Date | 04/15/2015
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Provider Practice Location Address
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Address Line | 310 JACKSON ST
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City | VIDALIA
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State | GA
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Zip | 30474-4708
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Country | US
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Telephone | 912-537-3377
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Fax | 912-538-7010
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Provider Business Mailing Address
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Address Line | 310 JACKSON ST
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City | VIDALIA
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State | GA
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Zip | 30474-4708
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Country | US
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Telephone | 912-537-3377
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Fax | 912-538-7010
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Authorized Official
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Title or Position | DENTAL ASSISTANT
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Name | TRACY ALLEN
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Credential |
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Telephone | 912-537-3377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN013906
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License Number State | GA
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