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General NPI Number Information
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NPI Number | 1497822167
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Entity Type | Organization
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Legal Business Name | KEVIN J. HALLGARTH, D.D.S., INC.
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 46 E STREETSBORO ST
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City | HUDSON
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State | OH
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Zip | 44236-3048
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Country | US
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Telephone | 330-650-1119
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Fax | 330-650-0836
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Provider Business Mailing Address
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Address Line | 5999 NICHOLSON DR
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City | HUDSON
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State | OH
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Zip | 44236-4409
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Country | US
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Telephone | 330-650-5025
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN JOE HALLGARTH
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Credential | D.D.S.
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Telephone | 330-650-1119
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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 | 30-01-9885
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License Number State | OH
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