Provider Demographics
NPI:1043363971
Name:HALSEMA, NANCY Z (DDS)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:Z
Last Name:HALSEMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3965 W 106TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7750
Mailing Address - Country:US
Mailing Address - Phone:317-253-8631
Mailing Address - Fax:317-876-9715
Practice Address - Street 1:3965 W 106TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7750
Practice Address - Country:US
Practice Address - Phone:317-253-8631
Practice Address - Fax:317-876-9715
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007944A1223G0001X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0612130996OtherHEALTH RESOURCES INC
IN691961OtherUNITED CONCORDIA