Provider Demographics
NPI:1982643623
Name:HALL, PHILLIP CLARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:CLARK
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 1:335 E SAINT GEORGE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7106
Mailing Address - Country:US
Mailing Address - Phone:435-634-8338
Mailing Address - Fax:435-218-7039
Practice Address - Street 1:335 E SAINT GEORGE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7106
Practice Address - Country:US
Practice Address - Phone:435-634-8338
Practice Address - Fax:435-218-7039
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1365611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice