Provider Demographics
NPI:1790791853
Name:HALL, BRANDON CONRAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:CONRAD
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 1:150 W. 9TH AVENUE
Mailing Address - Street 2:UNIT 1206
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204
Mailing Address - Country:US
Mailing Address - Phone:720-544-1491
Mailing Address - Fax:
Practice Address - Street 1:1590 LITTLE RAVEN STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202
Practice Address - Country:US
Practice Address - Phone:720-544-1491
Practice Address - Fax:720-544-1491
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190271711223G0001X
CO96621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice