Provider Demographics
NPI:1760692099
Name:HALL, STACEY S (DDS)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:S
Last Name:HALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5231 MONTICELLO AVE.,
Mailing Address - Street 2:SUITE E
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188
Mailing Address - Country:US
Mailing Address - Phone:757-565-6303
Mailing Address - Fax:757-565-6307
Practice Address - Street 1:5231 MONTICELLO AVE.,
Practice Address - Street 2:SUITE E
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188
Practice Address - Country:US
Practice Address - Phone:757-565-6303
Practice Address - Fax:757-565-6307
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice