Provider Demographics
NPI:1639262439
Name:HALLREN, MARTIN TIMOTHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:TIMOTHY
Last Name:HALLREN
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 1:1104 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3028
Mailing Address - Country:US
Mailing Address - Phone:580-256-3144
Mailing Address - Fax:580-256-1922
Practice Address - Street 1:1104 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3028
Practice Address - Country:US
Practice Address - Phone:580-256-3144
Practice Address - Fax:580-256-1922
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK44141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice