Provider Demographics
NPI:1174730204
Name:HALL, DENNIS A (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:A
Last Name:HALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DENNIS
Other - Middle Name:A
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3875 MELISSA LN
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-1253
Mailing Address - Country:US
Mailing Address - Phone:510-538-7889
Mailing Address - Fax:510-889-0939
Practice Address - Street 1:15803 HESPERIAN BLVD
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:CA
Practice Address - Zip Code:94580-1537
Practice Address - Country:US
Practice Address - Phone:510-276-1900
Practice Address - Fax:510-276-7894
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA228931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics