Provider Demographics
NPI:1245467125
Name:HALE, JOSEPH S (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:HALE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 FRASER VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-8205
Mailing Address - Country:US
Mailing Address - Phone:917-660-0290
Mailing Address - Fax:
Practice Address - Street 1:1580 SPACE CENTER DR
Practice Address - Street 2:SUITE 107
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-2445
Practice Address - Country:US
Practice Address - Phone:791-574-8922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10639122300000X
AZ7749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist