Provider Demographics
NPI:1942478755
Name:HALL, BRENDA JEAN (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:JEAN
Last Name:HALL
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 ZERMATT CT SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6566
Mailing Address - Country:US
Mailing Address - Phone:404-216-1981
Mailing Address - Fax:
Practice Address - Street 1:1463 KLONDIKE RD SW
Practice Address - Street 2:SUITE C
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5127
Practice Address - Country:US
Practice Address - Phone:770-483-9692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56541223S0112X
GADN0138201223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery