Provider Demographics
NPI:1023119187
Name:WOOD, BRENT CAMERON (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:CAMERON
Last Name:WOOD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:1425 WAKARUSA DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3832
Mailing Address - Country:US
Mailing Address - Phone:785-856-2483
Mailing Address - Fax:866-614-9189
Practice Address - Street 1:1425 WAKARUSA DR
Practice Address - Street 2:SUITE C
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3832
Practice Address - Country:US
Practice Address - Phone:785-856-2483
Practice Address - Fax:866-614-9189
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS602761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics