Provider Demographics
NPI:1609219187
Name:JOHNATHON J. HALE, D.D.S., PLLC
Entity Type:Organization
Organization Name:JOHNATHON J. HALE, D.D.S., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNATHON
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-465-5361
Mailing Address - Street 1:417 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-2198
Mailing Address - Country:US
Mailing Address - Phone:304-465-5361
Mailing Address - Fax:304-465-2227
Practice Address - Street 1:417 MAIN ST E
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2198
Practice Address - Country:US
Practice Address - Phone:304-465-5361
Practice Address - Fax:304-465-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV38581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810018173Medicaid