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General NPI Number Information
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NPI Number | 1053577460
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Entity Type | Organization
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Legal Business Name | A. LAVAR HALL D.D.S., INC
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 526 JEFFERSON ST
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City | GREENFIELD
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State | OH
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Zip | 45123-1356
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Country | US
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Telephone | 937-981-3184
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Fax |
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Provider Business Mailing Address
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Address Line | 526 JEFFERSON ST
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City | GREENFIELD
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State | OH
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Zip | 45123-1356
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Country | US
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Telephone | 937-981-3184
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTONE LAVAR HALL
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Credential | D.D.S.
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Telephone | 937-981-3184
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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 | 14762
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License Number State | OH
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