Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 60276 | KS |
NPI | 1023119187 |
---|---|
Provider Name | Dr. Brent Cameron Wood |
First Address | Lawrence, KS 66049-3832 |
Second Address | Lawrence, KS 66049-3832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |