Provider Demographics
NPI:1043835952
Name:WOOD, EMMA JOHNSON (DDS)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:JOHNSON
Last Name:WOOD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:CAITLIN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:BLDG 600 MCCAIN BLVD
Mailing Address - Street 2:BRANCH DENTAL CLINIC NAVAL AIR STATION NORTH ISLAND
Mailing Address - City:SAN DEIGO
Mailing Address - State:CA
Mailing Address - Zip Code:92135
Mailing Address - Country:US
Mailing Address - Phone:619-545-6397
Mailing Address - Fax:
Practice Address - Street 1:BLDG 600 MCCAIN BLVD
Practice Address - Street 2:BRANCH DENTAL CLINIC NAVAL AIR STATION NORTH ISLAND
Practice Address - City:SAN DEIGO
Practice Address - State:CA
Practice Address - Zip Code:92135
Practice Address - Country:US
Practice Address - Phone:619-545-6397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC118241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics