1679923510 NPI number — LYNETTA HALL DENTAL HYGIENIST

Table of content: LYNETTA HALL DENTAL HYGIENIST (NPI 1679923510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679923510 NPI number — LYNETTA HALL DENTAL HYGIENIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
LYNETTA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DENTAL HYGIENIST
Provider Gender Code:
F

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:
1679923510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4431 68TH STREET
Provider Second Line Business Mailing Address:
US ARMY DENTAL ACTIVITY
Provider Business Mailing Address City Name:
FORT HOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76544-5054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-287-5929
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
68TH STREET
Provider Second Line Business Practice Location Address:
US ARMY DENTAL ACTIVITY BLDG 4431
Provider Business Practice Location Address City Name:
FORT HOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-287-5929
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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