Provider Demographics
NPI:1871953091
Name:HALBERDENT
Entity type:Organization
Organization Name:HALBERDENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HALBERSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-253-6776
Mailing Address - Street 1:400 N FRANKSTON HWY
Mailing Address - Street 2:
Mailing Address - City:FRANKSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75763-2811
Mailing Address - Country:US
Mailing Address - Phone:903-876-3600
Mailing Address - Fax:
Practice Address - Street 1:400 N FRANKSTON HWY
Practice Address - Street 2:
Practice Address - City:FRANKSTON
Practice Address - State:TX
Practice Address - Zip Code:75763-2811
Practice Address - Country:US
Practice Address - Phone:903-876-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty