Provider Demographics
NPI:1275917395
Name:HALLIBURTON, BRITTNEY MARQEE (D D S)
Entity Type:Individual
Prefix:DR
First Name:BRITTNEY
Middle Name:MARQEE
Last Name:HALLIBURTON
Suffix:
Gender:F
Credentials:D D S
Other - Prefix:DR
Other - First Name:BRITTNEY
Other - Middle Name:MARQEE
Other - Last Name:MACKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:D D S
Mailing Address - Street 1:5124 STAGE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3164
Mailing Address - Country:US
Mailing Address - Phone:901-373-5433
Mailing Address - Fax:
Practice Address - Street 1:5124 STAGE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-3164
Practice Address - Country:US
Practice Address - Phone:901-373-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR40711223G0001X
TN102271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice