MEDICARE: DR. JOSEPH S HALE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	10639	CO
2	122300000X	Dentist	7749	AZ

General Provider Information

NPI Number	:	1245467125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH S HALE DMD

Provider Business Mailing Address
First Line	:	5222 FRASER VALLEY LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-8205
Country	:	US
Telephone Number	:	917-660-0290
Fax Number	:

Provider Business Practice Location Address
First Line	:	1580 SPACE CENTER DR
Second Line	:	SUITE 107
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-2445
Country	:	US
Telephone Number	:	791-574-8922
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	04/21/2014

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