MEDICARE: STEPHEN F. WOOD, D.D.S., PA

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	12524	TX

General Provider Information

NPI Number	:	1669695821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN F. WOOD, D.D.S., PA

Provider Business Mailing Address
First Line	:	4402 VANCE JACKSON RD
Second Line	:	SUITE 235
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-5336
Country	:	US
Telephone Number	:	210-558-3133
Fax Number	:	210-308-9062

Provider Business Practice Location Address
First Line	:	4402 VANCE JACKSON RD
Second Line	:	SUITE 235
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-5336
Country	:	US
Telephone Number	:	210-558-3133
Fax Number	:	210-308-9062

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. CORINNE R PIERCE
Credential	:
Telephone Number	:	210-558-3133

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	08/22/2020

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