1083726590 NPI number — STANTON H HALL DDS

Table of content: KATRINA MAREE GRANT MHW (NPI 1902573637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083726590 NPI number — STANTON H HALL DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STANTON H HALL DDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083726590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12817 120TH AVE NE
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
KIRKLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-821-7888
Provider Business Mailing Address Fax Number:
425-821-0412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12817 120TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-821-7888
Provider Business Practice Location Address Fax Number:
425-821-0412
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
STANTON
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
425-821-7888

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  5171 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com