Provider Demographics
NPI:1922011105
Name:HALUSIC, EDWARD JOHN JR (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOHN
Last Name:HALUSIC
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BESSEMER RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-9122
Mailing Address - Country:US
Mailing Address - Phone:724-547-0999
Mailing Address - Fax:724-547-5345
Practice Address - Street 1:220 BESSEMER RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-9122
Practice Address - Country:US
Practice Address - Phone:724-547-0999
Practice Address - Fax:724-547-5345
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-021856-L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS-021856-LOtherLICENSE NUMBER
PAFA044331OtherHIGHMARK PA BLUE SHIELD
PAFA044331OtherHIGHMARK PA BLUE SHIELD
PADS-021856-LOtherLICENSE NUMBER