Provider Demographics
NPI:1205090024
Name:WOODWARD, CHRISTINE A (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:A
Last Name:WOODWARD
Suffix:
Gender:F
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:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:CONCRETE
Mailing Address - State:WA
Mailing Address - Zip Code:98237-0570
Mailing Address - Country:US
Mailing Address - Phone:360-399-1250
Mailing Address - Fax:
Practice Address - Street 1:45860 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCRETE
Practice Address - State:WA
Practice Address - Zip Code:98237
Practice Address - Country:US
Practice Address - Phone:360-399-1250
Practice Address - Fax:360-404-3828
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60514482122300000X
WI6291-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2166381Medicaid