Provider Demographics
NPI:1427171297
Name:HALGREN, KERI L D (DDS)
Entity type:Individual
Prefix:DR
First Name:KERI
Middle Name:L D
Last Name:HALGREN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 E DIVISION STREET
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274
Mailing Address - Country:US
Mailing Address - Phone:360-424-7089
Mailing Address - Fax:
Practice Address - Street 1:1711 E DIVISION STREET
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274
Practice Address - Country:US
Practice Address - Phone:360-424-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist