Provider Demographics
NPI:1164565065
Name:HALE, ROBERT M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
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 1:8379 DAVISON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-2002
Mailing Address - Country:US
Mailing Address - Phone:810-653-7120
Mailing Address - Fax:810-653-3157
Practice Address - Street 1:8379 DAVISON RD
Practice Address - Street 2:SUITE A
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-2002
Practice Address - Country:US
Practice Address - Phone:810-653-7120
Practice Address - Fax:810-653-3157
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI124941223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health