Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 141719-9922 | UT |
NPI | 1740381490 |
---|---|
Provider Name | Dr. Jeffrey Kirk Wood |
First Address | Layton, UT 84040 |
Second Address | Clearfield, UT 84016-0074 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |