Provider Demographics
NPI:1043691850
Name:HALLINAN, BRYCE KYLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:KYLE
Last Name:HALLINAN
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 1:22 S GREENE ST
Mailing Address - Street 2:NGE08
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:410-706-3964
Mailing Address - Fax:
Practice Address - Street 1:190 GOOD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2353
Practice Address - Country:US
Practice Address - Phone:717-394-3033
Practice Address - Fax:717-394-5378
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0434381223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery