MEDICARE: DR. ROGER A HALL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS0000003078	TN

General Provider Information

NPI Number	:	1548319387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER A HALL DDS

Provider Business Mailing Address
First Line	:	4308 DALTON PIKE SE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-9305
Country	:	US
Telephone Number	:	423-479-1346
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 1ST ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-5007
Country	:	US
Telephone Number	:	423-472-9514
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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