Healthcare Provider Details

I. General information

NPI: 1992870927
Provider Name (Legal Business Name): LAURA L HALE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9605 GRAND RONDE RD
GRAND RONDE OR
97347-9712
US

IV. Provider business mailing address

608 LA JOYA ST STE B
ESPANOLA NM
87532-3467
US

V. Phone/Fax

Practice location:
  • Phone: 503-879-2020
  • Fax: 503-879-2071
Mailing address:
  • Phone: 505-753-9454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11922
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD3192
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number08516
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6648
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: