Provider Demographics
NPI:1447967492
Name:HALCOMB ORTHODONTICS LLC
Entity type:Organization
Organization Name:HALCOMB ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-398-0206
Mailing Address - Street 1:2542 E HALE ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-4104
Mailing Address - Country:US
Mailing Address - Phone:480-398-0206
Mailing Address - Fax:
Practice Address - Street 1:22480 E OCOTILLO RD
Practice Address - Street 2:SUITE 102
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142
Practice Address - Country:US
Practice Address - Phone:480-404-9311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty