Provider Demographics
NPI:1275655136
Name:HALE, KEVIN JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOSEPH
Last Name:HALE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10407 GRAND RIVER RD
Mailing Address - Street 2:SUITE #600
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6532
Mailing Address - Country:US
Mailing Address - Phone:810-227-9015
Mailing Address - Fax:810-227-6940
Practice Address - Street 1:10407 GRAND RIVER RD
Practice Address - Street 2:SUITE #600
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6532
Practice Address - Country:US
Practice Address - Phone:810-227-9015
Practice Address - Fax:810-227-6940
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI29010153971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS3D1539700OtherDENTAL PIN