Provider Demographics
NPI:1659581759
Name:HALL FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:HALL FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-345-0991
Mailing Address - Street 1:7350 S MCCLINTOCK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5006
Mailing Address - Country:US
Mailing Address - Phone:480-345-0991
Mailing Address - Fax:480-752-0822
Practice Address - Street 1:7350 S MCCLINTOCK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5006
Practice Address - Country:US
Practice Address - Phone:480-345-0991
Practice Address - Fax:480-752-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty