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General NPI Number Information
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NPI Number | 1861419640
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Entity Type | Organization
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Legal Business Name | HALVORSON & HEMBROUGH D.D.S, .M.S., PC
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 4355 SAWKAW DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-1768
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Country | US
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Telephone | 616-361-6609
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Fax | 616-361-6248
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Provider Business Mailing Address
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Address Line | 4355 SAWKAW DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-1768
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Country | US
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Telephone | 616-361-6609
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Fax | 616-361-6248
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. KATHERINE KLUNGLE
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Credential |
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Telephone | 616-361-6609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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