Provider Demographics
NPI:1487782132
Name:WOO, NELSON G (DMD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:G
Last Name:WOO
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 1:4508 HOLLY SPRINGS PARKWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115
Mailing Address - Country:US
Mailing Address - Phone:770-213-1726
Mailing Address - Fax:770-213-1727
Practice Address - Street 1:4508 HOLLY SPRINGS PARKWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115
Practice Address - Country:US
Practice Address - Phone:770-213-1726
Practice Address - Fax:770-213-1727
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0121791223G0001X
GADN012179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice