MEDICARE: HENRY A VAN HALA DDS INC

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	14482	OH

General Provider Information

NPI Number	:	1851401590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY A VAN HALA DDS INC

Provider Business Mailing Address
First Line	:	1515 PORTAGE ST NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720
Country	:	US
Telephone Number	:	330-494-0646
Fax Number	:	330-494-9181

Provider Business Practice Location Address
First Line	:	1515 PORTAGE ST NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720
Country	:	US
Telephone Number	:	330-494-0646
Fax Number	:	330-494-9181

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. HOLLACE G VAN HALA
Credential	:
Telephone Number	:	330-685-3737

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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