Provider Demographics
NPI:1871630194
Name:HALSTEAD DENTAL CLINIC PA
Entity Type:Organization
Organization Name:HALSTEAD DENTAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:316-835-2070
Mailing Address - Street 1:212 MAIN ST
Mailing Address - Street 2:P O BOX 209
Mailing Address - City:HALSTEAD
Mailing Address - State:KS
Mailing Address - Zip Code:67056-1913
Mailing Address - Country:US
Mailing Address - Phone:316-835-2070
Mailing Address - Fax:316-835-2008
Practice Address - Street 1:212 MAIN ST
Practice Address - Street 2:
Practice Address - City:HALSTEAD
Practice Address - State:KS
Practice Address - Zip Code:67056-1913
Practice Address - Country:US
Practice Address - Phone:316-835-2070
Practice Address - Fax:316-835-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS58571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty