Individual provider Active NPI

Dale Ronald Hallberg, DDS

Dentist
Flagstaff, AZ

National Provider Identifier

1881756641

Registry record updated Jun 17, 2020

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
NPI Registry JSON
Other providers in Flagstaff, AZ
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: DentistTaxonomy code 122300000X
License: 3680 Issued in AZ
Practice address: 2222 E Cedar Ave
Flagstaff, AZ 86004-1988
Phone: (928) 774-4412
NPI assigned: Dec 15, 2006
Sex: Male
Sole proprietor: No

NPPES NPI Registry

Updated by the provider on Jun 17, 2020

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	3680	AZ	Primary

Addresses

Primary practice location

2222 E Cedar Ave
Flagstaff, AZ 86004-1988

Mailing address

2222 E Cedar Ave
Flagstaff, AZ 86004-1988
Phone (928) 774-4412

Other practice location 1

608 N Humphreys St
Flagstaff, AZ 86001-3024
Phone (928) 774-4412

Electronic endpoints 6

Type	Endpoint	Use
Other URL	Flagstaff
Other URL	Flagstaff
Other URL	Flagstaff	Direct
Other URL	Flagstaff
Other URL	Flagstaff	Direct
Other URL	Flagstaff	Direct

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

National Provider Directory

Medicare enrollment (NPD): Enrolled

State licenses

License	State	Type	Specialty
3680	AZ	MD	Occupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592352000000",
    "number": "1881756641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 E CEDAR AVE",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041988",
            "telephone_number": "928-774-4412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 E CEDAR AVE",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041988",
            "telephone_number": "928-774-4412"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "608 N Humphreys St",
            "address_purpose": "LOCATION",
            "city": "Flagstaff",
            "state": "AZ",
            "postal_code": "860013024",
            "country_code": "US",
            "telephone_number": "928-774-4412",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HALLBERG",
        "first_name": "DALE",
        "middle_name": "RONALD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "3680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Flagstaff",
            "affiliation": "N",
            "address_1": "2222 E Cedar Ave",
            "city": "Flagstaff",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "860041988",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Flagstaff",
            "affiliation": "N",
            "address_1": "2222 E Cedar Ave",
            "city": "Flagstaff",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "860041988",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Flagstaff",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Flagstaff",
            "address_1": "2222 E Cedar Ave",
            "city": "Flagstaff",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "860041988",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Flagstaff",
            "affiliation": "N",
            "address_1": "2222 E Cedar Ave",
            "city": "Flagstaff",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "860041988",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Flagstaff",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Flagstaff",
            "address_1": "2222 E Cedar Ave",
            "city": "Flagstaff",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "860041988",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Flagstaff",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Flagstaff",
            "address_1": "2222 E Cedar Ave",
            "city": "Flagstaff",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "860041988",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; 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.