Halle Park Family Dentistry, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

HALLE PARK FAMILY DENTISTRY, P.C.

Practice address

1108 Halle Park Cir
Collierville, TN 38017-7084

Phone

(901) 457-7753

NPI assigned

Aug 18, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ettienne Van Zyl, D.D.S.

Title

President

Phone

(901) 457-7753

Specialties & licenses 6

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471478400000",
    "number": "1003361130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 NORTHCHASE PKWY SE",
            "address_2": "STE 150",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300676405",
            "telephone_number": "770-916-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 HALLE PARK CIR",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380177084",
            "telephone_number": "901-457-7753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALLE PARK FAMILY DENTISTRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-18",
        "last_updated": "2016-08-18",
        "status": "A",
        "authorized_official_last_name": "VAN ZYL",
        "authorized_official_first_name": "ETTIENNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-457-7753",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Collierville, TN
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.