Provider Demographics
NPI:1558489724
Name:HALL, TERRY CORNELIUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:CORNELIUS
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 1:424 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3322
Mailing Address - Country:US
Mailing Address - Phone:252-332-3265
Mailing Address - Fax:252-332-4703
Practice Address - Street 1:424 MAIN ST W
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3322
Practice Address - Country:US
Practice Address - Phone:252-332-3265
Practice Address - Fax:252-332-4703
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC54941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993462Medicaid
NCU37312Medicare UPIN