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General NPI Number Information
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NPI Number | 1962626861
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Entity Type | Individual
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Provider Name | EDDIE AL HALASA DDS,MSD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 71780 SAN JACINTO DR B3
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-5516
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Country | US
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Telephone | 760-779-0350
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Fax | 760-779-0348
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Provider Business Mailing Address
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Address Line | 71780 SAN JACINTO DR STE B3
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-5517
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Country | US
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Telephone | 760-779-0350
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Fax | 760-779-0348
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 50882
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License Number State | CA
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