Organization
KEN WOOD, D.D.S. M.S. CHILDRENS DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH I WOOD D.D.S., M.S. (DOCTOR)
(870) 931-5437
Entity
Organization
Contact information
Practice address
2702 S CULBERHOUSE ST, SUITE Q, JONESBORO, AR 72401-7132
(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
ARKANSAS BLUE CROSS BLUE
AR
01
—
828134
UNITED CONCORDIA
AR
Enumeration date
04/12/2007
Last updated
07/18/2007
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