Provider Demographics
NPI:1205024965
Name:KURT M. HALUM, DMD, PC
Entity Type:Organization
Organization Name:KURT M. HALUM, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:M
Authorized Official - Last Name:HALUM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:219-924-5437
Mailing Address - Street 1:2303 45TH ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2602
Mailing Address - Country:US
Mailing Address - Phone:219-924-5437
Mailing Address - Fax:
Practice Address - Street 1:2303 45TH ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2602
Practice Address - Country:US
Practice Address - Phone:219-924-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120096201223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12009620OtherINDIANA LICENSE