Provider Demographics
NPI:1346397395
Name:HALSTEAD, NATHAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:HALSTEAD
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 W SUPERIOR ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1701
Mailing Address - Country:US
Mailing Address - Phone:218-722-5233
Mailing Address - Fax:218-722-5661
Practice Address - Street 1:324 W SUPERIOR ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1701
Practice Address - Country:US
Practice Address - Phone:218-722-5233
Practice Address - Fax:218-722-5661
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND116151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND11615OtherAOA