1700947132 NPI number — DR. DENISE ANGELLA HALL DMD, MS, LLC

Table of content: DR. DENISE ANGELLA HALL DMD, MS, LLC (NPI 1700947132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700947132 NPI number — DR. DENISE ANGELLA HALL DMD, MS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
DENISE
Provider Middle Name:
ANGELLA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD, MS, LLC
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:
1700947132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3535 ROSWELL RD
Provider Second Line Business Mailing Address:
SUITE 14
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30062-8826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-321-9494
Provider Business Mailing Address Fax Number:
770-321-8511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3535 ROSWELL RD
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30062-8826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-321-9494
Provider Business Practice Location Address Fax Number:
770-321-8511
Provider Enumeration Date:
12/12/2006

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: 1223X0400X , with the licence number:  011414 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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