Provider Demographics
NPI:1275946816
Name:HALL, ANDREA LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 DODGE ST
Mailing Address - Street 2:APT. 1/2
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2725
Mailing Address - Country:US
Mailing Address - Phone:402-885-3851
Mailing Address - Fax:
Practice Address - Street 1:14202 Y ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2862
Practice Address - Country:US
Practice Address - Phone:402-895-2085
Practice Address - Fax:402-895-3144
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE69491223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics