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General NPI Number Information
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NPI Number | 1295584092
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Entity Type | Individual
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Provider Name | GEOFFREY THOMAS HALVERSEN
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Gender | Male
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Dates
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Enumeration Date | 05/14/2024
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Last Update Date | 08/09/2025
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Provider Practice Location Address
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Address Line | 5 ALLIED DR
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City | LITTLE ROCK
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State | AR
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Zip | 72202-2013
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Country | US
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Telephone | 501-437-8911
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Fax |
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Provider Business Mailing Address
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Address Line | 221 MEADOW LN
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City | MADISON
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State | IN
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Zip | 47250-2511
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Country | US
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Telephone | 812-599-5295
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 4799
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License Number State | AR
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