Provider Demographics
NPI:1588227722
Name:HALLIDAY, DARIUS V (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARIUS
Middle Name:V
Last Name:HALLIDAY
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 1:10924 E TRIPOLI AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-5442
Mailing Address - Country:US
Mailing Address - Phone:954-699-6253
Mailing Address - Fax:
Practice Address - Street 1:13721 ROSWELL AVE STE C
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5463
Practice Address - Country:US
Practice Address - Phone:909-627-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-14
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFH96196701223G0001X
390200000X
CA105155122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program