Healthcare Provider Details

I. General information

NPI: 1922011105
Provider Name (Legal Business Name): EDWARD JOHN HALUSIC JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 BESSEMER RD
MT PLEASANT PA
15666-9122
US

IV. Provider business mailing address

220 BESSEMER RD
MT PLEASANT PA
15666-9122
US

V. Phone/Fax

Practice location:
  • Phone: 724-547-0999
  • Fax: 724-547-5345
Mailing address:
  • Phone: 724-547-0999
  • Fax: 724-547-5345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS-021856-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: