Provider Demographics
NPI:1114905270
Name:HALE, HAL ELDIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAL
Middle Name:ELDIN
Last Name:HALE
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 1:1223 N ROCK RD
Mailing Address - Street 2:BUILDING F, SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1269
Mailing Address - Country:US
Mailing Address - Phone:316-687-0100
Mailing Address - Fax:316-686-0181
Practice Address - Street 1:1223 N ROCK RD
Practice Address - Street 2:BUILDING F, SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1269
Practice Address - Country:US
Practice Address - Phone:316-687-0100
Practice Address - Fax:316-686-0181
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-08
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS65421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA122005OtherMEDICARE
KS200691390BMedicaid