Provider Demographics
NPI:1942468202
Name:HALL FAMILY DENTISTRY
Entity Type:Organization
Organization Name:HALL FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMYE
Authorized Official - Middle Name:SHAMBURGER
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-267-5111
Mailing Address - Street 1:101 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-4110
Mailing Address - Country:US
Mailing Address - Phone:601-267-5111
Mailing Address - Fax:601-267-5335
Practice Address - Street 1:101 S PEARL ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-4110
Practice Address - Country:US
Practice Address - Phone:601-267-5111
Practice Address - Fax:601-267-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3421-07261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental