Healthcare Provider Details

I. General information

NPI: 1336268606
Provider Name (Legal Business Name): DENISE MARIE HALTER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2931 ESSARY DR
KNOXVILLE TN
37918
US

IV. Provider business mailing address

350 BLOUNTVILLE HWY STE 202
BRISTOL TN
37620-1671
US

V. Phone/Fax

Practice location:
  • Phone: 865-687-4450
  • Fax:
Mailing address:
  • Phone: 423-968-9661
  • Fax: 423-968-1593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number053375
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS9267
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: