Provider Demographics
NPI:1851401590
Name:HENRY A VAN HALA DDS INC
Entity Type:Organization
Organization Name:HENRY A VAN HALA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLACE
Authorized Official - Middle Name:G
Authorized Official - Last Name:VAN HALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-685-3737
Mailing Address - Street 1:1515 PORTAGE ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720
Mailing Address - Country:US
Mailing Address - Phone:330-494-0646
Mailing Address - Fax:330-494-9181
Practice Address - Street 1:1515 PORTAGE ST NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720
Practice Address - Country:US
Practice Address - Phone:330-494-0646
Practice Address - Fax:330-494-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty