Provider Demographics
NPI:1083612055
Name:HALL, RANDALL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:S
Last Name:HALL
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 1:255 UNION BLVD
Mailing Address - Street 2:SUITE 495
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1810
Mailing Address - Country:US
Mailing Address - Phone:303-989-1423
Mailing Address - Fax:
Practice Address - Street 1:255 UNION BLVD
Practice Address - Street 2:SUITE 495
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1810
Practice Address - Country:US
Practice Address - Phone:303-989-1423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:2006-02-05
Deactivation Code:
Reactivation Date:2007-05-17
Provider Licenses
StateLicense IDTaxonomies
COHD1007091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice