Healthcare Provider Details

I. General information

NPI: 1992466353
Provider Name (Legal Business Name): DANIEL HALL DMD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13350 CAMINO DEL SUR STE 3B
SAN DIEGO CA
92129-4473
US

IV. Provider business mailing address

13350 CAMINO DEL SUR STE 3B
SAN DIEGO CA
92129-4473
US

V. Phone/Fax

Practice location:
  • Phone: 858-215-2485
  • Fax: 858-905-3385
Mailing address:
  • Phone: 858-215-2485
  • Fax: 858-905-3385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DANIEL HALL
Title or Position: DENTIST/ OWNER
Credential: DMD
Phone: 858-215-2485