Provider Demographics
NPI:1962624544
Name:WOOD, BRYAN D (DDS)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:D
Last Name:WOOD
Suffix:
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 1:2000 HUNTINGTON AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-1728
Mailing Address - Country:US
Mailing Address - Phone:703-960-8670
Mailing Address - Fax:703-960-0267
Practice Address - Street 1:2000 HUNTINGTON AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303-1728
Practice Address - Country:US
Practice Address - Phone:703-960-8670
Practice Address - Fax:703-960-0267
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014114551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice