Healthcare Provider Details

I. General information

NPI: 1316960826
Provider Name (Legal Business Name): DAVID EDWARD HALL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N MILLS AVE STE 100
ORLANDO FL
32803-7103
US

IV. Provider business mailing address

610 N MILLS AVE STE 100
ORLANDO FL
32803-7103
US

V. Phone/Fax

Practice location:
  • Phone: 407-843-2261
  • Fax: 407-841-0247
Mailing address:
  • Phone: 407-843-2261
  • Fax: 407-841-0247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number24726
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: