Provider Demographics
NPI:1922130822
Name:HALL, JOHN KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KEVIN
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 1:3133 W MARCH LANE
Mailing Address - Street 2:SUITE 1080
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2360
Mailing Address - Country:US
Mailing Address - Phone:209-951-4304
Mailing Address - Fax:209-951-8910
Practice Address - Street 1:3133 W MARCH LANE
Practice Address - Street 2:SUITE 1080
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2360
Practice Address - Country:US
Practice Address - Phone:209-951-4304
Practice Address - Fax:209-951-8910
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist