Provider Demographics
NPI:1366606675
Name:WOOD CREEK DENTAL OF LANDRUM, PA
Entity type:Organization
Organization Name:WOOD CREEK DENTAL OF LANDRUM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:LEVI
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-457-3425
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:LANDRUM
Mailing Address - State:SC
Mailing Address - Zip Code:29356-0457
Mailing Address - Country:US
Mailing Address - Phone:864-457-3425
Mailing Address - Fax:
Practice Address - Street 1:1730 HIGHWAY 14 EAST
Practice Address - Street 2:
Practice Address - City:LANDRUM
Practice Address - State:SC
Practice Address - Zip Code:29356
Practice Address - Country:US
Practice Address - Phone:864-457-3425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty