MEDICARE: JOHN ANDREW WOOD 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	8861	CO

General Provider Information

NPI Number	:	1225104862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ANDREW WOOD DDS

Provider Business Mailing Address
First Line	:	102 LOREY DRIVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-7032
Country	:	US
Telephone Number	:	970-242-4945
Fax Number	:	970-242-0954

Provider Business Practice Location Address
First Line	:	102 LOREY DRIVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-7032
Country	:	US
Telephone Number	:	970-242-4945
Fax Number	:	970-242-0954

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/08/2007

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