MEDICARE: DR. STEVEN M HALL D.D.S

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	122300000X	Dentist	13153	MI

General Provider Information

NPI Number	:	1851311807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN M HALL D.D.S

Provider Business Mailing Address
First Line	:	1915 GEORGETOWN CENTER DR STE 101
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-7121
Country	:	US
Telephone Number	:	616-457-6800
Fax Number	:	616-457-8368

Provider Business Practice Location Address
First Line	:	1915 GEORGETOWN CENTER DR
Second Line	:	SUITE 101
City	:	JENISON
State	:	MI
Zip	:	49428-7121
Country	:	US
Telephone Number	:	616-457-6800
Fax Number	:	616-457-8368

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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