Provider Demographics
NPI:1962597864
Name:HALGREN, PAUL M (DDS,MSD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:HALGREN
Suffix:
Gender:M
Credentials:DDS,MSD
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 ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4501
Mailing Address - Country:US
Mailing Address - Phone:360-336-3436
Mailing Address - Fax:
Practice Address - Street 1:1711 E DIVISION ST
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4501
Practice Address - Country:US
Practice Address - Phone:360-336-3436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA100601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20-2318625OtherTIN