Active NPI
John Wesley Halliburton, DDS
- Dentist
- Cookeville, TN
National Provider Identifier
1780112177
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10520
- Practice address
- 22 N Jefferson Ave
Cookeville, TN 38501-3334 - Phone
- (931) 526-3381
- Fax
- (931) 520-4804
- NPI assigned
- May 30, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10520 | TN | Primary |
Addresses
Primary practice location
22 N Jefferson Ave
Cookeville, TN 38501-3334
Mailing address
22 N Jefferson Ave
Cookeville, TN 38501-3334
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10520 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1780112177",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 N JEFFERSON AVE",
"city": "COOKEVILLE",
"state": "TN",
"postal_code": "385013334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 N JEFFERSON AVE",
"city": "COOKEVILLE",
"state": "TN",
"postal_code": "385013334",
"telephone_number": "931-526-3381",
"fax_number": "931-520-4804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALLIBURTON",
"first_name": "JOHN",
"middle_name": "WESLEY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-05-30",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TN",
"license": "10520",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cookeville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.