Provider Demographics
NPI:1437721834
Name:HALLS, BRANDON (DMD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:HALLS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 S 66TH EAST AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1748
Mailing Address - Country:US
Mailing Address - Phone:918-477-7677
Mailing Address - Fax:
Practice Address - Street 1:6911 S 66TH EAST AVE STE 300
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1748
Practice Address - Country:US
Practice Address - Phone:918-477-7677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice