Provider Demographics
NPI:1467867663
Name:HALL, DANIEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
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 1:13350 CAMINO DEL SUR STE 3B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4473
Mailing Address - Country:US
Mailing Address - Phone:858-215-2485
Mailing Address - Fax:858-905-3385
Practice Address - Street 1:13350 CAMINO DEL SUR STE 3B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-4473
Practice Address - Country:US
Practice Address - Phone:858-215-2485
Practice Address - Fax:858-905-3385
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301341223G0001X
CA1033131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice