MEDICARE: DR. NATHAN GEORGE WOODS DDS

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	122300000X	Dentist	D6409	LA
2	1223E0200X	Endodontics	DD4658	NM
3	1223G0001X	General Practice Dentistry	D07243	AZ
4	1223E0200X	Endodontics	D07243	AZ

General Provider Information

NPI Number	:	1093909509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN GEORGE WOODS DDS

Provider Business Mailing Address
First Line	:	2855 E BROWN RD
Second Line	:	SUITE 15
City	:	MESA
State	:	AZ
Zip	:	85213-4213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2855 E BROWN RD
Second Line	:	SUITE 15
City	:	MESA
State	:	AZ
Zip	:	85213-4213
Country	:	US
Telephone Number	:	804-814-5801
Fax Number	:

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

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	06/25/2017

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