Provider Demographics
NPI:1407919541
Name:HALTOM, FELIX TUCKER (DDS MS)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:TUCKER
Last Name:HALTOM
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:TUCKER
Other - Middle Name:
Other - Last Name:HALTOM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS MS
Mailing Address - Street 1:10433 LAGRIMA DE ORO RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3727
Mailing Address - Country:US
Mailing Address - Phone:505-299-4458
Mailing Address - Fax:505-299-4450
Practice Address - Street 1:10433 LAGRIMA DE ORO RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3727
Practice Address - Country:US
Practice Address - Phone:505-299-4458
Practice Address - Fax:505-299-4450
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD9001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics