Provider Demographics
NPI:1821770124
Name:HALL, KATE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATE
Middle Name:ELIZABETH
Last Name:HALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:KATE
Other - Middle Name:ELIZABETH
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 ELLIS ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5244
Mailing Address - Country:US
Mailing Address - Phone:360-927-8229
Mailing Address - Fax:
Practice Address - Street 1:1100 ELLIS ST STE 1
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5244
Practice Address - Country:US
Practice Address - Phone:360-927-8299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61462817122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist