Provider Demographics
NPI:1356728059
Name:HALTERMAN, JOSEPH CORY (DMD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CORY
Last Name:HALTERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 STATE ST
Mailing Address - Street 2:#102
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3114
Mailing Address - Country:US
Mailing Address - Phone:805-687-6767
Mailing Address - Fax:
Practice Address - Street 1:3906 STATE ST
Practice Address - Street 2:#102
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3114
Practice Address - Country:US
Practice Address - Phone:805-687-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CADDS100272122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program