Healthcare Provider Details

I. General information

NPI: 1144603960
Provider Name (Legal Business Name): DONALD HALE DENTAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 1ST ST
BAY MINETTE AL
36507-4029
US

IV. Provider business mailing address

1281 MAIN ST
DAPHNE AL
36526-4420
US

V. Phone/Fax

Practice location:
  • Phone: 251-580-0979
  • Fax:
Mailing address:
  • Phone: 251-626-6869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6207
License Number StateAL

VIII. Authorized Official

Name: MARY L HEMPFLENG
Title or Position: OFFICE MANAGER
Credential:
Phone: 251-626-6869