MEDICARE: DIANA P WOOD, DMD

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		AL

General Provider Information

NPI Number	:	1891909560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANA P WOOD, DMD

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

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

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. THOMAS EASTWOOD GESTER
Credential	:
Telephone Number	:	205-937-3020

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	08/22/2020

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