Active NPI
Brent A. Hallum, DDS
- General Practice Dentistry
- Boerne, TX
National Provider Identifier
1801899323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 17249
- Practice address
- 804 N Main St
Boerne, TX 78006-1626 - Phone
- (830) 249-8407
- Fax
- (830) 249-6217
- NPI assigned
- May 30, 2005
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 17249 | TX | Primary |
Addresses
Primary practice location
804 N Main St
Boerne, TX 78006-1626
Mailing address
804 N Main St
Boerne, TX 78006-1626
Phone (830) 249-8407
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 |
|---|---|---|---|
| 17249 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801899323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "804 N MAIN ST",
"city": "BOERNE",
"state": "TX",
"postal_code": "780061626",
"telephone_number": "830-249-8407",
"fax_number": "830-249-6217"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "804 N MAIN ST",
"city": "BOERNE",
"state": "TX",
"postal_code": "780061626",
"telephone_number": "830-249-8407",
"fax_number": "830-249-6217"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALLUM",
"first_name": "BRENT",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "17249",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boerne, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.