Provider Demographics
NPI:1497822167
Name:KEVIN J. HALLGARTH, D.D.S., INC.
Entity Type:Organization
Organization Name:KEVIN J. HALLGARTH, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:HALLGARTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-650-1119
Mailing Address - Street 1:5999 NICHOLSON DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4409
Mailing Address - Country:US
Mailing Address - Phone:330-650-5025
Mailing Address - Fax:
Practice Address - Street 1:46 E STREETSBORO ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-3048
Practice Address - Country:US
Practice Address - Phone:330-650-1119
Practice Address - Fax:330-650-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-98851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty