# HALLE PARK FAMILY DENTISTRY, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003361130
- **Authorized official:** ETTIENNE VAN ZYL D.D.S. (PRESIDENT)
- **Authorized official phone:** (901) 457-7753

## Contact information

- **Practice address:** 1108 HALLE PARK CIR, COLLIERVILLE, TN 38017-7084
- **Practice address phone:** (901) 457-7753
- **Mailing address:** 1090 NORTHCHASE PKWY SE, STE 150, MARIETTA, GA 30067-6405
- **Mailing address phone:** (770) 916-5031

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0221X | Pediatric Dentistry | — | NULL | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | NULL | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |

## Other

- **Enumeration date:** 08/18/2016
- **Last updated:** 08/18/2016