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General NPI Number Information
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NPI Number | 1003933847
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Entity Type | Individual
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Provider Name | DWAYNE PRESTON HALL DDS
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Gender | Male
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Dates
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Enumeration Date | 03/25/2007
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Last Update Date | 08/27/2007
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Provider Practice Location Address
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Address Line | 5944 STETSON HILLS BLVD STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80922-2504
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Country | US
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Telephone | 719-638-2260
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Fax | 719-638-2261
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Provider Business Mailing Address
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Address Line | 3944 DIAMOND RIDGE VW
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-5623
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Country | US
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Telephone | 719-638-2260
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Fax | 719-638-2261
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8469
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License Number State | CO
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