Healthcare Provider Details

I. General information

NPI: 1952381154
Provider Name (Legal Business Name): JOHN CHRISTOPHER HALL DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4944 SKYVIEW CT
TRAVERSE CITY MI
49684-7173
US

IV. Provider business mailing address

4944 SKYVIEW CT
TRAVERSE CITY MI
49684-7173
US

V. Phone/Fax

Practice location:
  • Phone: 231-946-2910
  • Fax: 231-948-9114
Mailing address:
  • Phone: 319-462-9102
  • Fax: 231-946-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901016718
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: