1790214948 NPI number — DR. CAITLYN HALL DDS

Table of content: DR. CAITLYN HALL DDS (NPI 1790214948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790214948 NPI number — DR. CAITLYN HALL DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
CAITLYN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAND
Provider Other First Name:
CAITLYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790214948
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8305 NE WITT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMERON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64429-8028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 SWIFT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64116-3424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-471-2911
Provider Business Practice Location Address Fax Number:
816-527-9219
Provider Enumeration Date:
06/09/2017

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: 1223G0001X , with the licence number:  2017017884 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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