Healthcare Provider Details

I. General information

NPI: 1740284363
Provider Name (Legal Business Name): JEFFREY ALAN HALPERN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 LEE ST STE 640
DES PLAINES IL
60016-4548
US

IV. Provider business mailing address

701 LEE ST STE 640
DES PLAINES IL
60016-4548
US

V. Phone/Fax

Practice location:
  • Phone: 817-827-6300
  • Fax: 847-827-6306
Mailing address:
  • Phone: 817-827-6300
  • Fax: 847-827-6306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: