MEDICARE: BRANDON C HALL, DDS PC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1386341063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANDON C HALL, DDS PC

Provider Business Mailing Address
First Line	:	7995 E PRENTICE AVE STE 211
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2713
Country	:	US
Telephone Number	:	307-331-8371
Fax Number	:

Provider Business Practice Location Address
First Line	:	1590 LITTLE RAVEN ST STE 180
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-6186
Country	:	US
Telephone Number	:	720-675-8983
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF RCM
Name	:	KRYSTEN GARDUNO
Credential	:
Telephone Number	:	307-331-8371

Provider Enumeration Date	:	02/13/2023
Last Update Date	:	02/13/2023

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