Healthcare Provider Details

I. General information

NPI: 1457401200
Provider Name (Legal Business Name): DAVID LEE HALL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 12TH AVE #186
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

305 W 12TH AVE #186
COLUMBUS OH
43210-1267
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-3592
  • Fax: 614-292-8013
Mailing address:
  • Phone: 614-292-3592
  • Fax: 614-292-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15440
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: