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NPI Code Detail

MEDICARE: DEVON HALBERG DDS

MEDICARE: DEVON HALBERG DDS
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
1122300000XDentistD12783MN

General Provider Information

NPI Number : 1194044842
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEVON HALBERG DDS
Provider Business Mailing Address
First Line : 1632 WASHINGTON ST NE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-1336
Country : US
Telephone Number : 612-789-2853
Fax Number : 612-767-3490
Provider Business Practice Location Address
First Line : 1632 WASHINGTON ST NE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-1336
Country : US
Telephone Number : 612-789-2853
Fax Number : 612-767-3490
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2010
Last Update Date : 05/20/2010

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Directions to “ DEVON HALBERG DDS” Practice Location

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