Provider Demographics
NPI:1134314909
Name:HALLAK, LOJYN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOJYN
Middle Name:
Last Name:HALLAK
Suffix:JR
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 BRADSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2618
Mailing Address - Country:US
Mailing Address - Phone:800-417-4444
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:5555 E KINGS CANYON RD
Practice Address - Street 2:SU 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4532
Practice Address - Country:US
Practice Address - Phone:559-255-1122
Practice Address - Fax:559-255-1122
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56172122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD56172Medicaid