Provider Demographics
NPI:1437780137
Name:HALIFAX FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:HALIFAX FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MUNAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-367-3369
Mailing Address - Street 1:284 MONPONSETT ST STE 207
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:MA
Mailing Address - Zip Code:02338-1432
Mailing Address - Country:US
Mailing Address - Phone:781-293-7188
Mailing Address - Fax:
Practice Address - Street 1:284 MONPONSETT ST STE 207
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:MA
Practice Address - Zip Code:02338-1432
Practice Address - Country:US
Practice Address - Phone:781-293-7188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty