Provider Demographics
NPI:1649229956
Name:HALL, JEFFREY S (MD, DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:HALL
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9221 UNIVERSITY BLVD
Mailing Address - Street 2:BUILDING D, SUITE 1-A
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9148
Mailing Address - Country:US
Mailing Address - Phone:843-569-0904
Mailing Address - Fax:843-569-0961
Practice Address - Street 1:9221 UNIVERSITY BLVD
Practice Address - Street 2:BUILDING D, SUITE 1-A
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9148
Practice Address - Country:US
Practice Address - Phone:843-569-0904
Practice Address - Fax:843-569-0961
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9890Medicaid
SCZ29210Medicaid
SCZA9890Medicaid
SCZA9890Medicaid