Provider Demographics
NPI:1417401233
Name:HALL, JOSHUA J (DMD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:J
Last Name:HALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3790 WEDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-9319
Mailing Address - Country:US
Mailing Address - Phone:207-776-2323
Mailing Address - Fax:
Practice Address - Street 1:1915 LAKEMONT AVE UNIT 157
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6865
Practice Address - Country:US
Practice Address - Phone:207-776-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 222251223G0001X
OH30.0254561223G0001X
KY102371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice