Provider Demographics
NPI:1972664233
Name:HALL, MARK ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
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 1:161 12TH AVE W STE C
Mailing Address - Street 2:P. O. BOX 961
Mailing Address - City:GUIN
Mailing Address - State:AL
Mailing Address - Zip Code:35563-2257
Mailing Address - Country:US
Mailing Address - Phone:205-468-3339
Mailing Address - Fax:205-468-3773
Practice Address - Street 1:161 12TH AVE W STE C
Practice Address - Street 2:
Practice Address - City:GUIN
Practice Address - State:AL
Practice Address - Zip Code:35563-2257
Practice Address - Country:US
Practice Address - Phone:205-468-3339
Practice Address - Fax:205-468-3773
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL41601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice