Healthcare Provider Details

I. General information

NPI: 1629223367
Provider Name (Legal Business Name): CHRISTINE ANN HALKET D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 E STILL CIR
MESA AZ
85206-3631
US

IV. Provider business mailing address

5855 E STILL CIR
MESA AZ
85206-3631
US

V. Phone/Fax

Practice location:
  • Phone: 480-248-8162
  • Fax:
Mailing address:
  • Phone: 480-248-8162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7676
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number16963
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: