Individual
DR. KEITH HALLAIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.D.
Contact information
Practice address
80 MAPLE AVE, SMITHTOWN, NY 11787-3520
(631) 265-6533
(631) 265-6723
Mailing address
80 MAPLE AVE, SMITHTOWN, NY 11787-3520
(631) 265-6533
(631) 265-6723
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
048248
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02325744
—
NY
Enumeration date
02/16/2007
Last updated
07/08/2007
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