Healthcare Provider Details

I. General information

NPI: 1154490241
Provider Name (Legal Business Name): SARA ELIZABETH HALL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 MAIN ST
EAST JORDAN MI
49727-5114
US

IV. Provider business mailing address

121 MAIN ST PO BOX 638
EAST JORDAN MI
49727-5114
US

V. Phone/Fax

Practice location:
  • Phone: 865-518-1132
  • Fax:
Mailing address:
  • Phone: 865-518-1132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901021166
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS 8484
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: