=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275912891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT G HALE DDS APC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2015
-----------------------------------------------------
Last Update Date | 06/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6325 TOPANGA CANYON BLVD STE 435
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91367-2006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-999-0900
-----------------------------------------------------
Fax | 818-999-6927
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6325 TOPANGA CANYON BLVD STE 435
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91367-2006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-999-0900
-----------------------------------------------------
Fax | 818-999-6927
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBERT HALE
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 818-999-0900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | D29601
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------