Provider Demographics
NPI:1720209067
Name:HALL, ELIZABETH ELLEN (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ELLEN
Last Name:HALL
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5932 W PARKER RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6425
Mailing Address - Country:US
Mailing Address - Phone:972-612-2040
Mailing Address - Fax:972-867-6686
Practice Address - Street 1:5932 W PARKER RD
Practice Address - Street 2:SUITE 700
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6425
Practice Address - Country:US
Practice Address - Phone:972-612-2040
Practice Address - Fax:972-867-6686
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics