Provider Demographics
NPI:1316014376
Name:HALLER, EARL LEE (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:LEE
Last Name:HALLER
Suffix:
Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:2145 LOS GATOS ALMADEN RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124
Mailing Address - Country:US
Mailing Address - Phone:408-377-6050
Mailing Address - Fax:408-377-6190
Practice Address - Street 1:2145 LOS GATOS ALMADEN RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124
Practice Address - Country:US
Practice Address - Phone:408-377-6050
Practice Address - Fax:408-377-6190
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA255321223X0400X
MI101321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics