Healthcare Provider Details

I. General information

NPI: 1871630194
Provider Name (Legal Business Name): HALSTEAD DENTAL CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 MAIN ST
HALSTEAD KS
67056-1913
US

IV. Provider business mailing address

212 MAIN ST P O BOX 209
HALSTEAD KS
67056-1913
US

V. Phone/Fax

Practice location:
  • Phone: 316-835-2070
  • Fax: 316-835-2008
Mailing address:
  • Phone: 316-835-2070
  • Fax: 316-835-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5857
License Number StateKS

VIII. Authorized Official

Name: DR. ROBERT L SWEET
Title or Position: DENTIST
Credential: DDS PA
Phone: 316-835-2070