Provider Demographics
NPI:1619043080
Name:HALSBAND, EARLE ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:EARLE
Middle Name:ROBERT
Last Name:HALSBAND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2510
Mailing Address - Country:US
Mailing Address - Phone:508-755-0008
Mailing Address - Fax:508-770-0603
Practice Address - Street 1:9 LINDEN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2510
Practice Address - Country:US
Practice Address - Phone:508-755-0008
Practice Address - Fax:508-770-0603
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10436122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0263125Medicaid
T56998Medicare UPIN
MA0263125Medicaid