MEDICARE: JEAN WOO, DDS, P.A.

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	261QD0000X	Dental Clinic/Center	DN10017	FL

General Provider Information

NPI Number	:	1871659987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEAN WOO, DDS, P.A.

Provider Business Mailing Address
First Line	:	136 STAFF DR NE # B
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32548-5062
Country	:	US
Telephone Number	:	850-243-7177
Fax Number	:	850-243-4929

Provider Business Practice Location Address
First Line	:	136 STAFF DR NE # B
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32548-5062
Country	:	US
Telephone Number	:	850-243-7177
Fax Number	:	850-243-4929

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEAN WOO
Credential	:	D.D.S.
Telephone Number	:	850-243-7177

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	08/22/2020

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