Provider Demographics
NPI:1437297660
Name:HALL, MICHAEL EDMOND (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDMOND
Last Name:HALL
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 1:403 ROANOKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5007
Mailing Address - Country:US
Mailing Address - Phone:540-389-0225
Mailing Address - Fax:540-389-3529
Practice Address - Street 1:403 ROANOKE BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5007
Practice Address - Country:US
Practice Address - Phone:540-389-0225
Practice Address - Fax:540-389-3529
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010074361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice