Provider Demographics
NPI:1659436681
Name:O HALLORAN, KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:O HALLORAN
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:PO BOX 398
Mailing Address - Street 2:1211 N GLENN ENGLISH
Mailing Address - City:CORDELL
Mailing Address - State:OK
Mailing Address - Zip Code:73632
Mailing Address - Country:US
Mailing Address - Phone:580-832-3803
Mailing Address - Fax:580-832-3804
Practice Address - Street 1:1211 N GLENN ENGLISH
Practice Address - Street 2:
Practice Address - City:CORDELL
Practice Address - State:OK
Practice Address - Zip Code:73632
Practice Address - Country:US
Practice Address - Phone:580-832-3803
Practice Address - Fax:580-832-3804
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist