Provider Demographics
NPI:1114064862
Name:HALL, JOHN C JR (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:HALL
Suffix:JR
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 1:3850 S OSPREY AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6831
Mailing Address - Country:US
Mailing Address - Phone:941-952-1790
Mailing Address - Fax:941-952-9846
Practice Address - Street 1:3850 S OSPREY AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6831
Practice Address - Country:US
Practice Address - Phone:941-952-1790
Practice Address - Fax:941-952-9846
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN77111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice