Provider Demographics
NPI:1558586313
Name:HAYGOOD, CHRISTOPHER RYAN I (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:RYAN
Last Name:HAYGOOD
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 DOCTORS DR # -1
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3321
Mailing Address - Country:US
Mailing Address - Phone:318-797-3505
Mailing Address - Fax:318-797-3655
Practice Address - Street 1:1519 DOCTORS DR # -1
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3321
Practice Address - Country:US
Practice Address - Phone:318-797-3505
Practice Address - Fax:318-797-3655
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist