Provider Demographics
NPI:1497858302
Name:GERALD D. HALBACH, D.D.S., P.C.
Entity Type:Organization
Organization Name:GERALD D. HALBACH, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HALBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-292-0606
Mailing Address - Street 1:4801 NORTH FIRST AVENUE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5612
Mailing Address - Country:US
Mailing Address - Phone:520-292-0606
Mailing Address - Fax:
Practice Address - Street 1:4801 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5612
Practice Address - Country:US
Practice Address - Phone:520-292-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty