MEDICARE: JOHN ROGER 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	1223G0001X	General Practice Dentistry	24624	CA

General Provider Information

NPI Number	:	1588631410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ROGER WOOD DDS

Provider Business Mailing Address
First Line	:	1519 S OREGON ST
Second Line	:
City	:	YREKA
State	:	CA
Zip	:	96097-3425
Country	:	US
Telephone Number	:	530-842-9200
Fax Number	:	530-842-9207

Provider Business Practice Location Address
First Line	:	1519 S OREGON ST
Second Line	:
City	:	YREKA
State	:	CA
Zip	:	96097-3425
Country	:	US
Telephone Number	:	530-842-9200
Fax Number	:	530-842-9207

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	11/14/2007

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