Healthcare Provider Details

I. General information

NPI: 1588860506
Provider Name (Legal Business Name): CHRISTINE RENEE HALLIDAY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 GLENN AVENUE
WASHINGTON CH OH
43160
US

IV. Provider business mailing address

211 GLENN AVENUE
WASHINGTON CH OH
43160
US

V. Phone/Fax

Practice location:
  • Phone: 740-335-7905
  • Fax: 740-333-7817
Mailing address:
  • Phone: 740-335-7905
  • Fax: 740-333-7817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21206
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: