Provider Demographics
NPI:1710781638
Name:WEST FLORIDA PERIODONTAL ASSOCIATES, P. A.
Entity type:Organization
Organization Name:WEST FLORIDA PERIODONTAL ASSOCIATES, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:850-476-8419
Mailing Address - Street 1:6111 N DAVIS HWY STE B
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6913
Mailing Address - Country:US
Mailing Address - Phone:850-476-8418
Mailing Address - Fax:
Practice Address - Street 1:6111 N DAVIS HWY STE B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6913
Practice Address - Country:US
Practice Address - Phone:850-476-8418
Practice Address - Fax:850-474-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty