Provider Demographics
NPI:1740287432
Name:HALL, KELVIN WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:WAYNE
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 1:450 SUTTER ST
Mailing Address - Street 2:SUITE 1330
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4206
Mailing Address - Country:US
Mailing Address - Phone:415-981-8592
Mailing Address - Fax:415-981-8599
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:SUITE 1330
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-981-8592
Practice Address - Fax:415-981-8599
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-04-19
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
CA287021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice