Provider Demographics
NPI:1881827921
Name:HALL, LUCINDA JANE (DDS)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:JANE
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 1:4019 W 12600 S STE 100
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7402
Mailing Address - Country:US
Mailing Address - Phone:801-253-8633
Mailing Address - Fax:
Practice Address - Street 1:4019 W 12600 S STE 100
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-7402
Practice Address - Country:US
Practice Address - Phone:801-253-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57663122300000X
UT103911991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist