Provider Demographics
NPI:1043381130
Name:HALL, TIMOTHY MORRIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MORRIS
Last Name:HALL
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 1:147 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757-2109
Mailing Address - Country:US
Mailing Address - Phone:423-566-0573
Mailing Address - Fax:423-562-1133
Practice Address - Street 1:147 NORTH ST
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-2109
Practice Address - Country:US
Practice Address - Phone:423-566-0573
Practice Address - Fax:423-562-1133
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS-70091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice