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General NPI Number Information
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NPI Number | 1174180574
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Entity Type | Individual
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Provider Name | MICHAEL JORDAN HALCOMB DDS
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Gender | Male
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Dates
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Enumeration Date | 05/22/2019
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 22480 E OCOTILLO RD SUITE 102
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City | QUEEN CREEK
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State | AZ
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Zip | 85142
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Country | US
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Telephone | 480-404-9311
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Fax |
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Provider Business Mailing Address
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Address Line | 2542 E HALE ST
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City | MESA
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State | AZ
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Zip | 85213-4104
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Country | US
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Telephone | 480-398-0206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D011212
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License Number State | AZ
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