Provider Demographics
NPI:1699080432
Name:JAMES W HALLIDAY JR DMD LLC
Entity type:Organization
Organization Name:JAMES W HALLIDAY JR DMD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HALLIDAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-283-0454
Mailing Address - Street 1:908 HIGHLAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-8051
Mailing Address - Country:US
Mailing Address - Phone:907-283-0454
Mailing Address - Fax:907-283-0456
Practice Address - Street 1:908 HIGHLAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-8051
Practice Address - Country:US
Practice Address - Phone:907-283-0454
Practice Address - Fax:907-283-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKD1148261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD9411Medicaid