MEDICARE: DANIEL J. HALASZ DMD, LLC

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	1223G0001X	General Practice Dentistry	4029	SC

General Provider Information

NPI Number	:	1497025829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL J. HALASZ DMD, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1182
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-1182
Country	:	US
Telephone Number	:	864-288-9780
Fax Number	:	864-627-0733

Provider Business Practice Location Address
First Line	:	6 WINCHESTER CT
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2627
Country	:	US
Telephone Number	:	864-288-9780
Fax Number	:	864-627-0733

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL HALASZ
Credential	:	D.M.D.
Telephone Number	:	864-293-6450

Provider Enumeration Date	:	01/02/2012
Last Update Date	:	01/02/2012

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