Active NPI
Mark David Wood, DDS, MS
- Endodontics
- Lafayette, CO
National Provider Identifier
1992703102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 7818
- Practice address
- 1140 W South Boulder Rd Ste 103
Lafayette, CO 80026-8910 - Phone
- (303) 604-9663
- Fax
- (303) 666-9213
- NPI assigned
- Jul 12, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 7818 | CO | Primary |
Addresses
Primary practice location
1140 W South Boulder Rd Ste 103
Lafayette, CO 80026-8910
Mailing address
1140 W South Boulder Rd Ste 103
Lafayette, CO 80026-8910
Phone (303) 604-9663
Other practice location 1
1200 W South Boulder Rd
Suite 103
Lafayette, CO 80026-3546
Phone (303) 604-9663
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1402935 | Other | PA | UNITED CONCORDIA ID # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 19, 2020 through Oct 19, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7818 | CO | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683763200000",
"number": "1992703102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1140 W SOUTH BOULDER RD STE 103",
"city": "LAFAYETTE",
"state": "CO",
"postal_code": "800268910",
"telephone_number": "303-604-9663",
"fax_number": "303-666-9213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1140 W SOUTH BOULDER RD STE 103",
"city": "LAFAYETTE",
"state": "CO",
"postal_code": "800268910",
"telephone_number": "303-604-9663",
"fax_number": "303-666-9213"
}
],
"practiceLocations": [
{
"address_1": "1200 W South Boulder Rd",
"address_2": "Suite 103",
"address_purpose": "LOCATION",
"city": "Lafayette",
"state": "CO",
"postal_code": "800263546",
"country_code": "US",
"telephone_number": "303-604-9663",
"fax_number": "303-666-9213",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WOOD",
"first_name": "MARK",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-12",
"last_updated": "2023-05-11",
"certification_date": "2023-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CO",
"license": "7818",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA ID #",
"identifier": "1402935",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.