MEDICARE: DR. BRYCE KYLE HALLINAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS043438	PA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1043691850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYCE KYLE HALLINAN D.D.S.

Provider Business Mailing Address
First Line	:	22 S GREENE ST
Second Line	:	NGE08
City	:	BALTIMORE
State	:	MD
Zip	:	21201-1544
Country	:	US
Telephone Number	:	410-706-3964
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 GOOD DR
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17603-2353
Country	:	US
Telephone Number	:	717-394-3033
Fax Number	:	717-394-5378

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2015
Last Update Date	:	03/18/2022

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