Healthcare Provider Details

I. General information

NPI: 1952770703
Provider Name (Legal Business Name): BRIAN D HALL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 SOLAREX CT SUITE 202
FREDERICK MD
21703-7005
US

IV. Provider business mailing address

604 SOLAREX CT SUITE 202
FREDERICK MD
21703-7005
US

V. Phone/Fax

Practice location:
  • Phone: 301-696-2000
  • Fax:
Mailing address:
  • Phone: 301-696-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12333
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: