MEDICARE: WOOD & SPOONER, LLC

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	AL4846	AL
2	1223G0001X	General Practice Dentistry	AL3561	AL

General Provider Information

NPI Number	:	1679928972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOOD & SPOONER, LLC

Provider Business Mailing Address
First Line	:	3020 BRIARCLIFF RD
Second Line	:
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-1303
Country	:	US
Telephone Number	:	205-937-3020
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 MONTGOMERY HWY
Second Line	:	SUITE 201
City	:	VESTAVIA
State	:	AL
Zip	:	35216-1862
Country	:	US
Telephone Number	:	205-822-2808
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MR. TOM E GESTER
Credential	:
Telephone Number	:	205-937-3020

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	04/25/2016

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Directions to “WOOD & SPOONER, LLC ” Practice Location

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