Provider Demographics
NPI:1700153764
Name:NICHOLLS AND HALDERMAN, D.D.S., INC.
Entity Type:Organization
Organization Name:NICHOLLS AND HALDERMAN, D.D.S., INC.
Other - Org Name:NORTHSTONE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HALDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-890-1333
Mailing Address - Street 1:1730 SCHROCK RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1575
Mailing Address - Country:US
Mailing Address - Phone:614-890-1333
Mailing Address - Fax:614-890-4945
Practice Address - Street 1:1730 SCHROCK RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1575
Practice Address - Country:US
Practice Address - Phone:614-890-1333
Practice Address - Fax:614-890-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30022403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty