Provider Demographics
NPI:1477973444
Name:HALL, KASHIF RU-SHON JU-JUAN (DDS)
Entity Type:Individual
Prefix:
First Name:KASHIF
Middle Name:RU-SHON JU-JUAN
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 1:1103 W FRIENDLY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1863
Mailing Address - Country:US
Mailing Address - Phone:336-641-3152
Mailing Address - Fax:
Practice Address - Street 1:1103 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1863
Practice Address - Country:US
Practice Address - Phone:336-641-3152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC105341223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health