Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | D6409 | LA |
Y | 1223E0200X | Endodontist | D07243 | AZ |
N | 1223E0200X | Endodontist | DD4658 | NM |
N | 1223G0001X | General Practice | D07243 | AZ |
N | 213EG0000X | General Practice | D07243 | AZ |
NPI | 1093909509 |
---|---|
Provider Name | Dr. Nathan George Woods |
First Address | Mesa, AZ 85213-4213 |
Second Address | Mesa, AZ 85213-4213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2007 |
Last Update Date | 25/06/2017 |