Provider Demographics
NPI:1780035253
Name:HALL, AMANDA H (DDS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:H
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 1:17965 US HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-6906
Mailing Address - Country:US
Mailing Address - Phone:901-466-0501
Mailing Address - Fax:901-466-1130
Practice Address - Street 1:17965 US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-6906
Practice Address - Country:US
Practice Address - Phone:901-466-0501
Practice Address - Fax:901-466-1130
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10285122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist