Provider Demographics
NPI:1972573194
Name:HOOD, K MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:K
Middle Name:MICHAEL
Last Name:HOOD
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 1:4602 N 16TH ST
Mailing Address - Street 2:SUITE #302
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5189
Mailing Address - Country:US
Mailing Address - Phone:602-234-3679
Mailing Address - Fax:
Practice Address - Street 1:4602 N 16TH ST
Practice Address - Street 2:SUITE #302
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5189
Practice Address - Country:US
Practice Address - Phone:602-234-3679
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice