Healthcare Provider Details

I. General information

NPI: 1902467889
Provider Name (Legal Business Name): DYLAN KENT HALL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2019
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 6TH ST
GROTTOES VA
24441-1735
US

IV. Provider business mailing address

108 6TH ST
GROTTOES VA
24441-1735
US

V. Phone/Fax

Practice location:
  • Phone: 540-249-4242
  • Fax: 540-249-4732
Mailing address:
  • Phone: 540-249-4242
  • Fax: 828-652-6526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401417798
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: