Provider Demographics
NPI:1629292925
Name:HALLUM, CARL OLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:OLE
Last Name:HALLUM
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 1:724 KENTUCKY AVE
Mailing Address - Street 2:P.O. BOX 117
Mailing Address - City:ADRIAN
Mailing Address - State:MN
Mailing Address - Zip Code:56110-1085
Mailing Address - Country:US
Mailing Address - Phone:507-483-2626
Mailing Address - Fax:
Practice Address - Street 1:113 N MAINE AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MN
Practice Address - Zip Code:56110-1072
Practice Address - Country:US
Practice Address - Phone:507-483-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND84951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice