Provider Demographics
NPI:1346423290
Name:J.W. HALTOM D.D.S., INC.
Entity Type:Organization
Organization Name:J.W. HALTOM D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HALTOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-385-6935
Mailing Address - Street 1:320 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLEFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79339-3821
Mailing Address - Country:US
Mailing Address - Phone:806-385-6935
Mailing Address - Fax:806-385-6937
Practice Address - Street 1:320 E 8TH ST
Practice Address - Street 2:
Practice Address - City:LITTLEFIELD
Practice Address - State:TX
Practice Address - Zip Code:79339-3821
Practice Address - Country:US
Practice Address - Phone:806-385-6935
Practice Address - Fax:806-385-6937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty