Provider Demographics
NPI:1124142195
Name:HALUM, MARIETTA MORALEDA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIETTA
Middle Name:MORALEDA
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:CORNER WEST SIDE AVENUE
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:201-434-3070
Practice Address - Street 1:151 KENSINGTON AVE
Practice Address - Street 2:CORNER WEST SIDE AVENUE
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1805
Practice Address - Country:US
Practice Address - Phone:201-434-3070
Practice Address - Fax:201-434-3070
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI163571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice