Provider Demographics
NPI:1841318078
Name:HALUM, MARISSA (DMD)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:HALUM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1805
Mailing Address - Country:US
Mailing Address - Phone:201-434-3070
Mailing Address - Fax:732-356-0038
Practice Address - Street 1:111 E UNION AVE
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1713
Practice Address - Country:US
Practice Address - Phone:732-356-1830
Practice Address - Fax:732-356-0038
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023060001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry