Healthcare Provider Details

I. General information

NPI: 1245346147
Provider Name (Legal Business Name): CHRISTIAN HAGLUND WOODHEAD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 09/21/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7197 HIGHBRIDGE RD
FAYETTEVILLE NY
13066
US

IV. Provider business mailing address

PO BOX 11170
SYRACUSE NY
13218
US

V. Phone/Fax

Practice location:
  • Phone: 315-637-7684
  • Fax:
Mailing address:
  • Phone: 315-637-7684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number50 052304
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: