Provider Demographics
NPI:1790857613
Name:HALCOVICH, JOHN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:HALCOVICH
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 1:875 EMPRESS RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5553
Mailing Address - Country:US
Mailing Address - Phone:610-294-7994
Mailing Address - Fax:610-294-7995
Practice Address - Street 1:254 CAFFERTY RD
Practice Address - Street 2:
Practice Address - City:PIPERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18947-9337
Practice Address - Country:US
Practice Address - Phone:610-294-7994
Practice Address - Fax:610-294-7995
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027410L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015918110Medicaid