Provider Demographics
NPI:1184782880
Name:HALL, LEONIDAS BRODIE (DDS)
Entity type:Individual
Prefix:DR
First Name:LEONIDAS
Middle Name:BRODIE
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 1:4629 9TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-7109
Mailing Address - Country:US
Mailing Address - Phone:202-829-2472
Mailing Address - Fax:202-829-2345
Practice Address - Street 1:4629 9TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7109
Practice Address - Country:US
Practice Address - Phone:202-829-2472
Practice Address - Fax:202-829-2345
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3061122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist