Provider Demographics
NPI:1386631349
Name:DOUGLAS R HALLORAN DDS INC
Entity Type:Organization
Organization Name:DOUGLAS R HALLORAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HALLORAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-224-9925
Mailing Address - Street 1:1100 W SHAW AVE
Mailing Address - Street 2:STE 146
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3708
Mailing Address - Country:US
Mailing Address - Phone:559-224-9925
Mailing Address - Fax:559-224-4478
Practice Address - Street 1:1100 W SHAW AVE
Practice Address - Street 2:STE 146
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3708
Practice Address - Country:US
Practice Address - Phone:559-224-9925
Practice Address - Fax:559-224-4478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43532122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB43532 01OtherDENTI CAL