MEDICARE: DR. MINDY MARIE HALL D.M.D.

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	1223P0221X	Pediatric Dentistry	DN17086	FL

General Provider Information

NPI Number	:	1649208547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINDY MARIE HALL D.M.D.

Provider Business Mailing Address
First Line	:	3725 12TH CT
Second Line	:	SUITE B
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6543
Country	:	US
Telephone Number	:	772-562-6880
Fax Number	:	772-562-6895

Provider Business Practice Location Address
First Line	:	3725 12TH CT
Second Line	:	SUITE B
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6543
Country	:	US
Telephone Number	:	772-562-6880
Fax Number	:	772-562-6895

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	05/04/2016

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