Individual
KEN I WOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
2702 CULBERHOUSE, SOUTHWEST VILLAGE, JONESBORO, AR 72401
(870) 931-5437
(870) 931-9781
Mailing address
PO BOX 1369, JONESBORO, AR 72403-1369
(870) 931-5437
(870) 931-9781
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2738
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59239
BLUE CROSS BLUE SHIELD
—
01
—
828134
UNITED CONCORDIA
—
Enumeration date
09/25/2006
Last updated
07/08/2007
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