Healthcare Provider Details

I. General information

NPI: 1982040945
Provider Name (Legal Business Name): JOY ESTELLE HALL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GIRARD ST STE 206
GAITHERSBURG MD
20877-3490
US

IV. Provider business mailing address

8630 FENTON STREET SUITE 1204
SLIVER SPRING MD
20910-3490
US

V. Phone/Fax

Practice location:
  • Phone: 240-499-2636
  • Fax: 240-499-2602
Mailing address:
  • Phone: 336-847-2409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number6864
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHYG1000701
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number8823
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0402205485
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: