Provider Demographics
NPI:1801899323
Name:HALLUM, BRENT A (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:A
Last Name:HALLUM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1626
Mailing Address - Country:US
Mailing Address - Phone:830-249-8407
Mailing Address - Fax:830-249-6217
Practice Address - Street 1:804 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1626
Practice Address - Country:US
Practice Address - Phone:830-249-8407
Practice Address - Fax:830-249-6217
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice