MEDICARE: RYAN WOOD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN013124	GA

General Provider Information

NPI Number	:	1093899122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN WOOD

Provider Business Mailing Address
First Line	:	1200 SHERWOOD PARK DR NE
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3445
Country	:	US
Telephone Number	:	770-532-4555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 SHERWOOD PARK DR NE
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3445
Country	:	US
Telephone Number	:	770-532-4555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/17/2012

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Directions to “ RYAN WOOD ” Practice Location

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