Provider Demographics
NPI:1851331326
Name:HALLIGAN, KELLY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:A
Last Name:HALLIGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:PETERS
Other - Last Name:HALLIGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:595 CHAPEL HILLS DR STE 105
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1024
Mailing Address - Country:US
Mailing Address - Phone:719-475-2511
Mailing Address - Fax:
Practice Address - Street 1:595 CHAPEL HILLS DR. STE. 105
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-2502
Practice Address - Country:US
Practice Address - Phone:719-475-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195891223G0001X
CO100361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice