Provider Demographics
NPI:1760569040
Name:HALL, RAY SAMUEL II (DDS)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:SAMUEL
Last Name:HALL
Suffix:II
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 1:8900 NATION RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47620-9050
Mailing Address - Country:US
Mailing Address - Phone:812-455-5144
Mailing Address - Fax:
Practice Address - Street 1:8900 NATION RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IN
Practice Address - Zip Code:47620-9050
Practice Address - Country:US
Practice Address - Phone:812-455-5144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008391A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist