Provider Demographics
NPI:1770612400
Name:HALL, ANTHONY CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CHARLES
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 1:5541 HWY 10 EAST
Mailing Address - Street 2:SUITE A
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481
Mailing Address - Country:US
Mailing Address - Phone:715-344-7911
Mailing Address - Fax:
Practice Address - Street 1:5541 HWY 10 EAST
Practice Address - Street 2:SUITE A
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481
Practice Address - Country:US
Practice Address - Phone:715-344-7911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33731400Medicare ID - Type UnspecifiedMEDICAL ASSISTANCE