Provider Demographics
NPI:1841429354
Name:HALL, BERKLEY JESSE JR (DMD)
Entity Type:Individual
Prefix:
First Name:BERKLEY
Middle Name:JESSE
Last Name:HALL
Suffix:JR
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 1:10592 E ROSE HILL ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5963
Mailing Address - Country:US
Mailing Address - Phone:520-647-1987
Mailing Address - Fax:
Practice Address - Street 1:631 W VALENCIA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-7640
Practice Address - Country:US
Practice Address - Phone:520-812-6736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7814122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist