Provider Demographics
NPI:1700044542
Name:HALL, KEVIN ALLAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ALLAN
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:PO BOX 2094
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06145-2094
Mailing Address - Country:US
Mailing Address - Phone:860-278-4163
Mailing Address - Fax:860-278-5995
Practice Address - Street 1:1841 BROAD ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1780
Practice Address - Country:US
Practice Address - Phone:860-278-4163
Practice Address - Fax:860-278-5995
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0077801223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health