Healthcare Provider Details

I. General information

NPI: 1689582967
Provider Name (Legal Business Name): HALLIDAY DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180 LA JOLLA VILLAGE DR STE 210
LA JOLLA CA
92037-1471
US

IV. Provider business mailing address

4180 LA JOLLA VILLAGE DR STE 210
LA JOLLA CA
92037-1471
US

V. Phone/Fax

Practice location:
  • Phone: 858-326-3381
  • Fax: 858-326-3047
Mailing address:
  • Phone: 858-326-3381
  • Fax: 858-326-3047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DARIUS HALLIDAY
Title or Position: CEO
Credential: DDS
Phone: 954-699-6253