Provider Demographics
NPI:1811109317
Name:DYM, HAL MARSHALL (DMD)
Entity type:Individual
Prefix:DR
First Name:HAL
Middle Name:MARSHALL
Last Name:DYM
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 1:11 DRURY LANE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117
Mailing Address - Country:US
Mailing Address - Phone:860-236-3874
Mailing Address - Fax:
Practice Address - Street 1:170 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118
Practice Address - Country:US
Practice Address - Phone:860-568-3366
Practice Address - Fax:860-569-3421
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist