Provider Demographics
NPI:1104904515
Name:WOO, PHILIP M JR (DMD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:M
Last Name:WOO
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 LOVELL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931
Mailing Address - Country:US
Mailing Address - Phone:814-472-4644
Mailing Address - Fax:814-472-4588
Practice Address - Street 1:171 LOVELL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931
Practice Address - Country:US
Practice Address - Phone:814-472-4644
Practice Address - Fax:814-472-4588
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023541L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist