Provider Demographics
NPI:1770562928
Name:WOODHEAD, RODERICK PETER (DDS)
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:PETER
Last Name:WOODHEAD
Suffix:
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 1:215 ISLIP AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3013
Mailing Address - Country:US
Mailing Address - Phone:631-277-7741
Mailing Address - Fax:
Practice Address - Street 1:215 ISLIP AVE
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3013
Practice Address - Country:US
Practice Address - Phone:631-277-7741
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0410301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001101422Medicaid