Provider Demographics
NPI:1477645737
Name:HALLE, JEROME DENARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:DENARY
Last Name:HALLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 MONTGOMERY BLVD NE
Mailing Address - Street 2:BLDG C STE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109
Mailing Address - Country:US
Mailing Address - Phone:505-889-3777
Mailing Address - Fax:505-830-1027
Practice Address - Street 1:7520 MONTGOMERY BLVD NE
Practice Address - Street 2:BLDG C STE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-889-3777
Practice Address - Fax:505-830-1027
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD1200122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist