Provider Demographics
NPI:1194971952
Name:WOOD, ROBERT ADAMS (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ADAMS
Last Name:WOOD
Suffix:
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 1:11607 BRAE VLY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3852
Mailing Address - Country:US
Mailing Address - Phone:801-403-5712
Mailing Address - Fax:
Practice Address - Street 1:11607 BRAE VLY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3852
Practice Address - Country:US
Practice Address - Phone:801-403-5712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXUTSA 855-X1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics