Provider Demographics
NPI:1992703102
Name:WOOD, MARK DAVID (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:WOOD
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W SOUTH BOULDER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8910
Mailing Address - Country:US
Mailing Address - Phone:303-604-9663
Mailing Address - Fax:303-666-9213
Practice Address - Street 1:1140 W SOUTH BOULDER RD STE 103
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8910
Practice Address - Country:US
Practice Address - Phone:303-604-9663
Practice Address - Fax:303-666-9213
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO78181223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1402935OtherUNITED CONCORDIA ID #