Provider Demographics
NPI:1457089815
Name:HALLY DENTAL LLC
Entity Type:Organization
Organization Name:HALLY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KORBIN
Authorized Official - Middle Name:DEANE
Authorized Official - Last Name:HALLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-844-6333
Mailing Address - Street 1:2600 TAYLER ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 TAYLER ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-2134
Practice Address - Country:US
Practice Address - Phone:405-844-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental