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General NPI Number Information
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NPI Number | 1942452545
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Entity Type | Organization
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Legal Business Name | BRIAN HALLER DMD LLC
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 602 W 6TH ST
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City | ROLLA
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State | MO
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Zip | 65401-2941
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Country | US
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Telephone | 573-364-7969
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 393
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City | ROLLA
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State | MO
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Zip | 65402-0393
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Country | US
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Telephone | 573-364-7969
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN HALLER
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Credential | DMD
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Telephone | 573-364-7969
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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 | 013842
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License Number State | MO
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