Provider Demographics
NPI:1861419640
Name:HALVORSON & HEMBROUGH D.D.S, .M.S., PC
Entity type:Organization
Organization Name:HALVORSON & HEMBROUGH D.D.S, .M.S., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLUNGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-361-6609
Mailing Address - Street 1:4355 SAWKAW DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1768
Mailing Address - Country:US
Mailing Address - Phone:616-361-6609
Mailing Address - Fax:616-361-6248
Practice Address - Street 1:4355 SAWKAW DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1768
Practice Address - Country:US
Practice Address - Phone:616-361-6609
Practice Address - Fax:616-361-6248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty