Provider Demographics
NPI:1750476008
Name:HALL, ANTONE LAVAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTONE
Middle Name:LAVAR
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 1:526 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-1356
Mailing Address - Country:US
Mailing Address - Phone:937-981-3184
Mailing Address - Fax:937-981-3184
Practice Address - Street 1:526 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-1356
Practice Address - Country:US
Practice Address - Phone:937-981-3184
Practice Address - Fax:937-981-3184
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH147621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0368678Medicaid