Provider Demographics
NPI:1487850277
Name:HALLIWELL, DAVID H III (DDS DENTIST)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:HALLIWELL
Suffix:III
Gender:M
Credentials:DDS DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 SOUTH 25TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7399
Mailing Address - Country:US
Mailing Address - Phone:601-545-8615
Mailing Address - Fax:601-545-8616
Practice Address - Street 1:314 SOUTH 25TH AVENUE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7399
Practice Address - Country:US
Practice Address - Phone:601-545-8615
Practice Address - Fax:601-343-8616
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1800781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA735590OtherUNITED CONCORDIA INSURANCE COMPANY