MEDICARE: TANIKA HALE D.D.S.

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	3777-14	MS
2	1223G0001X	General Practice Dentistry	7167	LA

General Provider Information

NPI Number	:	1740696434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIKA HALE D.D.S.

Provider Business Mailing Address
First Line	:	4704 VETERANS MEMORIAL BLVD STE 102
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70006-5343
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	954 MANHATTAN BLVD
Second Line	:
City	:	HARVEY
State	:	LA
Zip	:	70058-4606
Country	:	US
Telephone Number	:	504-370-9220
Fax Number	:

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

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	07/03/2023

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