Montez Delver Hallback, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401419233 Issued in VA

Practice address

434 Southbridge St Ste B
Auburn, MA 01501-4423

Phone

(508) 752-6649

NPI assigned

Jun 25, 2024

Last updated

Nov 19, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EJBDAA

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Vernon J Harris East End Community Health Center

  dba Capital Area Health Network

  • Federally Qualified Health Center (FQHC)
  • Richmond, VA
  • NPI 1295707966
  Medicare reassignment NPD
• Vernon J Harris East End Community Health Center

  dba Capital Area Health Network - Henderson Health Services

  • Federally Qualified Health Center (FQHC)
  • Richmond, VA
  • NPI 1366920530
  NPD
• Vernon J Harris East End Community Health Center

  dba Capital Area Health Network - Vernon J. Harris Medical Center

  • Federally Qualified Health Center (FQHC)
  • Richmond, VA
  • NPI 1972636330
  NPD

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

{
    "created_epoch": "1719273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1477398196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 SOUTHBRIDGE ST STE B",
            "city": "AUBURN",
            "state": "MA",
            "postal_code": "015014423",
            "telephone_number": "508-752-6649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 SOUTHBRIDGE ST STE B",
            "city": "AUBURN",
            "state": "MA",
            "postal_code": "015014423",
            "telephone_number": "508-752-6649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLBACK",
        "first_name": "MONTEZ",
        "middle_name": "DELVER",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-25",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401419233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerry H Gurwitz, MD
• Michael Gusar, D.M.D.
• Lisa Marie Haddon, RN
• Caitlin Hagan
• Anastasia Nicole Hall, PT
• William Hamill, DPT
• Hesham M. a. Hammouda, M.D.
• Jason P Hantavis, MSPT, CSCS, OCS
• Brianna Marie Harrington
• Stefanie R. Haynes

• General Practice Dentistry in Auburn, MA
• Providers in Auburn, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.