Provider Demographics
NPI:1952381154
Name:HALL, JOHN CHRISTOPHER (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:HALL
Suffix:
Gender:M
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 1:4944 SKYVIEW CT
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7173
Mailing Address - Country:US
Mailing Address - Phone:319-462-9102
Mailing Address - Fax:231-946-9114
Practice Address - Street 1:4944 SKYVIEW CT
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7173
Practice Address - Country:US
Practice Address - Phone:231-946-2910
Practice Address - Fax:231-948-9114
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010167181223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901016718OtherDENTAL LICENSE
383418411OtherTAX ID