Provider Demographics
NPI:1275912891
Name:ROBERT G HALE DDS APC
Entity Type:Organization
Organization Name:ROBERT G HALE DDS APC
Other - Org Name:WOODLAND HILLS ORAL & MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-999-0900
Mailing Address - Street 1:6325 TOPANGA CANYON BLVD
Mailing Address - Street 2:STE 435
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2006
Mailing Address - Country:US
Mailing Address - Phone:818-999-0900
Mailing Address - Fax:818-999-6927
Practice Address - Street 1:6325 TOPANGA CANYON BLVD
Practice Address - Street 2:STE 435
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2006
Practice Address - Country:US
Practice Address - Phone:818-999-0900
Practice Address - Fax:818-999-6927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD296011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD29601OtherMEDICARE PROVIDER
CAU28248Medicare UPIN