Provider Demographics
NPI:1508948720
Name:HALL, DAVID GEORGE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GEORGE
Last Name:HALL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:G
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:1820 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-6228
Mailing Address - Country:US
Mailing Address - Phone:918-336-6789
Mailing Address - Fax:918-336-6432
Practice Address - Street 1:1820 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-6228
Practice Address - Country:US
Practice Address - Phone:918-336-6789
Practice Address - Fax:918-336-6432
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics