Provider Demographics
NPI:1407557085
Name:J.M. HALLIE INC.
Entity Type:Organization
Organization Name:J.M. HALLIE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:M
Authorized Official - Last Name:HALLIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-463-2553
Mailing Address - Street 1:201 4TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROSEAU
Mailing Address - State:MN
Mailing Address - Zip Code:56751-1033
Mailing Address - Country:US
Mailing Address - Phone:218-463-2553
Mailing Address - Fax:218-463-9464
Practice Address - Street 1:201 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:ROSEAU
Practice Address - State:MN
Practice Address - Zip Code:56751-1033
Practice Address - Country:US
Practice Address - Phone:218-463-2553
Practice Address - Fax:218-463-9464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty