Provider Demographics
NPI:1306056593
Name:HALLEY, VINCEN JAMES (DDS)
Entity type:Individual
Prefix:
First Name:VINCEN
Middle Name:JAMES
Last Name:HALLEY
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 1:806 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4349
Mailing Address - Country:US
Mailing Address - Phone:405-377-1155
Mailing Address - Fax:405-377-1914
Practice Address - Street 1:806 S PINE ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4349
Practice Address - Country:US
Practice Address - Phone:405-377-1155
Practice Address - Fax:405-377-1914
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK59281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice