Provider Demographics
NPI:1629160163
Name:HALL, DAVID REEVES (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:REEVES
Last Name:HALL
Suffix:
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 1:101 E SOUTHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4552
Mailing Address - Country:US
Mailing Address - Phone:641-753-3383
Mailing Address - Fax:641-753-8495
Practice Address - Street 1:101 E SOUTHRIDGE RD
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4552
Practice Address - Country:US
Practice Address - Phone:641-753-3383
Practice Address - Fax:641-753-8495
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA59641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA845914OtherUNITED CONCORDIA
IA0129460Medicaid
IA12946OtherDELTA DENTAL OF IOWA