Provider Demographics
NPI:1396904405
Name:HABERLAND, CHRISTEL MARIA (DDS)
Entity type:Individual
Prefix:
First Name:CHRISTEL
Middle Name:MARIA
Last Name:HABERLAND
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 1:1810 MACKENZIE DR FL 2
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2967
Mailing Address - Country:US
Mailing Address - Phone:614-273-2250
Mailing Address - Fax:614-273-2255
Practice Address - Street 1:477 COOPER RD STE 480
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8095
Practice Address - Country:US
Practice Address - Phone:614-823-7135
Practice Address - Fax:614-823-7137
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300212681223P0106X
FLDN161411223P0221X
SC441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0029887Medicaid