Provider Demographics
NPI:1043387335
Name:HALIHAN, RANDY JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:JOSEPH
Last Name:HALIHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6108 WHITING DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-1705
Mailing Address - Country:US
Mailing Address - Phone:815-271-5484
Mailing Address - Fax:
Practice Address - Street 1:475 W TERRA COTTA AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3407
Practice Address - Country:US
Practice Address - Phone:815-444-6444
Practice Address - Fax:815-444-6446
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice