Provider Demographics
NPI:1336241678
Name:HALL, DANIEL DEAN (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:DEAN
Last Name:HALL
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 1:405 WEST ROANE AVE
Mailing Address - Street 2:
Mailing Address - City:EUPORA
Mailing Address - State:MS
Mailing Address - Zip Code:39744
Mailing Address - Country:US
Mailing Address - Phone:662-258-2224
Mailing Address - Fax:662-258-4412
Practice Address - Street 1:405 WEST ROANE AVE
Practice Address - Street 2:
Practice Address - City:EUPORA
Practice Address - State:MS
Practice Address - Zip Code:39744
Practice Address - Country:US
Practice Address - Phone:662-258-2224
Practice Address - Fax:662-258-4412
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS201583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00060002Medicaid