Provider Demographics
NPI:1083281026
Name:TIMOTHY M HALL DMD PC
Entity Type:Organization
Organization Name:TIMOTHY M HALL DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MORRIS
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:423-566-0573
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty