Provider Demographics
NPI:1104981786
Name:WOOD, CECIL JR (DDS)
Entity type:Individual
Prefix:DR
First Name:CECIL
Middle Name:
Last Name:WOOD
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 BLUEBONNET LN
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-4204
Mailing Address - Country:US
Mailing Address - Phone:214-549-2134
Mailing Address - Fax:972-576-8082
Practice Address - Street 1:724 S CEDAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2204
Practice Address - Country:US
Practice Address - Phone:972-298-4209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice