Provider Demographics
NPI:1023367125
Name:HALUSKA, DAVID CHRISTOPHER (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHRISTOPHER
Last Name:HALUSKA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 STILLWATER AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3984
Mailing Address - Country:US
Mailing Address - Phone:207-941-6550
Mailing Address - Fax:207-973-5932
Practice Address - Street 1:12 STILLWATER AVE
Practice Address - Street 2:STE 6
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3984
Practice Address - Country:US
Practice Address - Phone:207-941-6550
Practice Address - Fax:207-973-5932
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4267122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist