Provider Demographics
NPI:1164545745
Name:HALLS ADVANCED DENTISTRY & IMPLANT CENTER PLLC
Entity Type:Organization
Organization Name:HALLS ADVANCED DENTISTRY & IMPLANT CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:928-352-5550
Mailing Address - Street 1:308 N WHITE MOUNTAIN RD
Mailing Address - Street 2:SUITE #D
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-5260
Mailing Address - Country:US
Mailing Address - Phone:928-532-5550
Mailing Address - Fax:928-537-4109
Practice Address - Street 1:308 N WHITE MOUNTAIN RD
Practice Address - Street 2:SUITE #D
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-5260
Practice Address - Country:US
Practice Address - Phone:928-242-0016
Practice Address - Fax:928-537-4109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty