Provider Demographics
NPI:1922788009
Name:HOUSEHOLDER, HALI (RDH, OMT, BSPH)
Entity Type:Individual
Prefix:
First Name:HALI
Middle Name:
Last Name:HOUSEHOLDER
Suffix:
Gender:F
Credentials:RDH, OMT, BSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3697 WALNUT HILL CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-7603
Mailing Address - Country:US
Mailing Address - Phone:317-919-0116
Mailing Address - Fax:
Practice Address - Street 1:3697 WALNUT HILL CT
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-7603
Practice Address - Country:US
Practice Address - Phone:317-919-0116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13007283A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist