Provider Demographics
NPI:1821297193
Name:LEONARD H HALTIWANGER, DMD, MS, PA
Entity Type:Organization
Organization Name:LEONARD H HALTIWANGER, DMD, MS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:HELMS
Authorized Official - Last Name:HALTIWANGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:910-997-2204
Mailing Address - Street 1:719 S LONG DR
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4315
Mailing Address - Country:US
Mailing Address - Phone:910-997-2204
Mailing Address - Fax:910-997-4950
Practice Address - Street 1:719 S LONG DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4315
Practice Address - Country:US
Practice Address - Phone:910-997-2204
Practice Address - Fax:910-997-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6566261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental