Provider Demographics
NPI:1770629750
Name:HALL, JAMIE L (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:L
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 1:200 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3248
Mailing Address - Country:US
Mailing Address - Phone:814-942-1890
Mailing Address - Fax:814-942-0673
Practice Address - Street 1:200 UNION AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-3248
Practice Address - Country:US
Practice Address - Phone:814-942-1890
Practice Address - Fax:814-942-0673
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0354941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice