MEDICARE: DR. GERRY DWAINE WOODS D.D.S.

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	122300000X	Dentist	19581	CA

General Provider Information

NPI Number	:	1902089576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERRY DWAINE WOODS D.D.S.

Provider Business Mailing Address
First Line	:	595 E COLORADO BLVD STE 603
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-5219
Country	:	US
Telephone Number	:	626-795-2544
Fax Number	:

Provider Business Practice Location Address
First Line	:	595 E COLORADO BLVD STE 603
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-5219
Country	:	US
Telephone Number	:	626-795-2544
Fax Number	:

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

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	12/06/2007

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Directions to “ DR. GERRY DWAINE WOODS D.D.S.” Practice Location

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