Provider Demographics
NPI:1023033446
Name:HALL, TERESA MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:HALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 PLEASANT GROVE BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6126
Mailing Address - Country:US
Mailing Address - Phone:916-772-6248
Mailing Address - Fax:916-772-6235
Practice Address - Street 1:953 PLEASANT GROVE BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6126
Practice Address - Country:US
Practice Address - Phone:916-772-6248
Practice Address - Fax:916-772-6235
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice