MEDICARE: TERRY R. WOOD, DDS, INC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	25102	CA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	34589	CA
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	24419	CA

General Provider Information

NPI Number	:	1750386645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRY R. WOOD, DDS, INC

Provider Business Mailing Address
First Line	:	515 W. PUTNAM AVE
Second Line	:
City	:	PORTERVILLE
State	:	CA
Zip	:	93257
Country	:	US
Telephone Number	:	559-781-7685
Fax Number	:	559-781-1825

Provider Business Practice Location Address
First Line	:	515 W. PUTNAM AVE
Second Line	:
City	:	PORTERVILLE
State	:	CA
Zip	:	93257
Country	:	US
Telephone Number	:	559-781-7685
Fax Number	:	559-781-1825

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. TERRY R WOOD
Credential	:	DDS
Telephone Number	:	559-781-7685

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/22/2020

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