MEDICARE: SAMANTHA WOOD BSDH, OMT

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	124Q00000X	Dental Hygienist	21351	TX
2	174400000X	Specialist

General Provider Information

NPI Number	:	1851281471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA WOOD BSDH, OMT

Provider Business Mailing Address
First Line	:	6328 MALVEY AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4509
Country	:	US
Telephone Number	:	817-781-3350
Fax Number	:

Provider Business Practice Location Address
First Line	:	6328 MALVEY AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4509
Country	:	US
Telephone Number	:	817-781-3350
Fax Number	:

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

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	07/07/2025

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