Provider Demographics
NPI:1518189380
Name:HALL, LAJUAN MICHELLE (DDS)
Entity Type:Individual
Prefix:
First Name:LAJUAN
Middle Name:MICHELLE
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 1:5201 DEER VALLEY RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-7431
Mailing Address - Country:US
Mailing Address - Phone:925-756-2024
Mailing Address - Fax:925-756-7158
Practice Address - Street 1:5201 DEER VALLEY RD STE 2A
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-7431
Practice Address - Country:US
Practice Address - Phone:925-756-2024
Practice Address - Fax:925-756-7158
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA446881223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry