Provider Demographics
NPI:1659462430
Name:HALL, ANDREW DRAKE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DRAKE
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 1:8610 EXPLORER DR
Mailing Address - Street 2:SUITE #315
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1058
Mailing Address - Country:US
Mailing Address - Phone:719-599-0700
Mailing Address - Fax:
Practice Address - Street 1:8610 EXPLORER DR
Practice Address - Street 2:SUITE #315
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1058
Practice Address - Country:US
Practice Address - Phone:719-599-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO89281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice