Organization
HALLIBURTON FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE VIVIAN HALLIBURTON DDS (OWNER)
(917) 687-0722
Entity
Organization
Contact information
Practice address
5096 DORSEY HALL DR STE 106, ELLICOTT CITY, MD 21042-7711
(917) 687-0722
Mailing address
9218 MAGGIES WAY, LAUREL, MD 20723-1376
(917) 687-0722
(443) 545-5299
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/13/2020
Last updated
03/13/2020
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