Organization
HALLIBURTON ORTHODONTICS,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD RICHARD HALLIBURTON, D.D.S., M.S. (PRESIDENT)
(423) 246-3001
Entity
Organization
Contact information
Practice address
1335 E CENTER ST, KINGSPORT, TN 37664-2489
(423) 246-3001
Mailing address
1335 E CENTER ST, KINGSPORT, TN 37664-2489
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4057154
BLUE CROSS BLUE SHIELD
TN
01
—
843715
UNITED CONCORDIA
—
Enumeration date
04/23/2007
Last updated
08/22/2020
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