Provider Demographics
NPI:1366404410
Name:HALE, ROBERT GLENN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GLENN
Last Name:HALE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 TOPANGA CANYON BLVD
Mailing Address - Street 2:STE 435
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2046
Mailing Address - Country:US
Mailing Address - Phone:818-999-0900
Mailing Address - Fax:818-999-6927
Practice Address - Street 1:6325 TOPANGA CANYON BLVD
Practice Address - Street 2:STE 435
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2046
Practice Address - Country:US
Practice Address - Phone:818-999-0900
Practice Address - Fax:818-999-6927
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA94311223S0112X
CA296011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB29601-01OtherDENTI-CAL
CAD29601OtherMEDICARE PROVIDER
CAD29601OtherMEDICARE PROVIDER