1255691705 NPI number — DR. EMILY CAROLINE HALLE DMD

Table of content: DR. EMILY CAROLINE HALLE DMD (NPI 1255691705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255691705 NPI number — DR. EMILY CAROLINE HALLE DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALLE
Provider First Name:
EMILY
Provider Middle Name:
CAROLINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLUPKA
Provider Other First Name:
EMILY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255691705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
340 FRANKLIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLIPPERY ROCK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16057-1164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-794-2000
Provider Business Mailing Address Fax Number:
724-794-4546

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLIPPERY ROCK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16057-1164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-794-2000
Provider Business Practice Location Address Fax Number:
724-794-4546
Provider Enumeration Date:
05/17/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  0000000000 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)