Provider Demographics
NPI:1841315215
Name:HALL, BRUCE ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
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 1:931 ARLINGTON ST
Mailing Address - Street 2:STE 3
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4025
Mailing Address - Country:US
Mailing Address - Phone:580-332-0431
Mailing Address - Fax:580-332-1362
Practice Address - Street 1:931 ARLINGTON ST
Practice Address - Street 2:STE 3
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4025
Practice Address - Country:US
Practice Address - Phone:580-332-0431
Practice Address - Fax:580-332-1362
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice