Provider Demographics
NPI:1649208547
Name:HALL, MINDY MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:MARIE
Last Name:HALL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3725 12TH CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6543
Mailing Address - Country:US
Mailing Address - Phone:772-562-6880
Mailing Address - Fax:772-562-6895
Practice Address - Street 1:3725 12TH CT
Practice Address - Street 2:SUITE B
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6543
Practice Address - Country:US
Practice Address - Phone:772-562-6880
Practice Address - Fax:772-562-6895
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN170861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry