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General NPI Number Information
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NPI Number | 1871953091
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Entity Type | Organization
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Legal Business Name | HALBERDENT
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Dates
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Enumeration Date | 03/01/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 400 N FRANKSTON HWY
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City | FRANKSTON
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State | TX
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Zip | 75763-2811
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Country | US
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Telephone | 903-876-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 400 N FRANKSTON HWY
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City | FRANKSTON
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State | TX
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Zip | 75763-2811
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Country | US
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Telephone | 903-876-3600
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. KYLE WILLIAM HALBERSTADT
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Credential | DDS
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Telephone | 903-253-6776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 29934
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License Number State | TX
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