Provider Demographics
NPI:1013043637
Name:HALL, SHAI TANYETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAI
Middle Name:TANYETTE
Last Name:HALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 MCMILLAN AVE
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-1132
Mailing Address - Country:US
Mailing Address - Phone:404-210-9297
Mailing Address - Fax:
Practice Address - Street 1:1503 MCMILLAN AVE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1132
Practice Address - Country:US
Practice Address - Phone:251-809-6058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0129761223G0001X
AL5969-C122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice