Provider Demographics
NPI:1053425447
Name:HALDEMAN, JAMES DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DANIEL
Last Name:HALDEMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 NORTHWOODS BLVD
Mailing Address - Street 2:SUITE #120
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4711
Mailing Address - Country:US
Mailing Address - Phone:614-846-7300
Mailing Address - Fax:614-846-7452
Practice Address - Street 1:170 NORTHWOODS BLVD
Practice Address - Street 2:SUITE #120
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4711
Practice Address - Country:US
Practice Address - Phone:614-846-7300
Practice Address - Fax:614-846-7452
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7129820001Medicare NSC