Provider Demographics
NPI:1548393903
Name:HALL, AUGUSTUS ALONZO III (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTUS
Middle Name:ALONZO
Last Name:HALL
Suffix:III
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 1:8427 KELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4806
Mailing Address - Country:US
Mailing Address - Phone:225-928-9838
Mailing Address - Fax:225-928-7838
Practice Address - Street 1:8427 KELWOOD AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4806
Practice Address - Country:US
Practice Address - Phone:225-928-9838
Practice Address - Fax:225-928-7838
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA54781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice